Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Morphological Studies on the Papilla of Vater, the Minor Papilla, the Peri-Vaterian Diverticulum, and the Promontory; with Special Reference to Their Changes with Aging and Relations to the Pancreatico-Biliary Diseases (Part-II)
Isao ISHIKAWA
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Keywords: Promontory
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1976 Volume 73 Issue 9 Pages 1022-1036

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Abstract

In this part, the minor papilla, the peri-Vaterian diverticulum and the promontory (Eaton, 1969) were studied. One hundred twenty eight specimens from 202 autopsy cases used in the previous study were injected a radio-opaque material from amputated orifices of choledochus, pancreatic duct and duodenal canal and analyzed radiographically. Macroscopic and histological analyses were made on treated materials before and after subsequent formalin fixation.
1. The minor papilla was noted in 96.2% of the materials examined. Three types may be classified by its front view; round (59.4%), oval (29.8%), and unclassified (7.0%) types. Histologically the minor papilla showed a similar structure to that of the papilla of Vater. Since the minor papilla showed a significant relation to the pancreatic diseases, its alterations in clinical diagnosis of the pancreatic diseases is as effective as the alterations of the papilla of Vater.
2. The peri-Vaterian diverticulum may be classified into two types morphologically and histogenetically; Group-I, a diverticulum larger than 5mm in diameter, appeared near the major papilla and represents a classic term of the peri-Vaterian diverticulum. Group-II, a diverticulum smaller than 5mm in diameter, appeared multiply at the lowest part of the frenulum or bilateral to the frenulum at regular distance. Group-I appeared adjacent to the choledochus. Its incidence increased parallel to advancing age up to 30% in the group over 60 years. Group-II located at the site where vasculatures penetrated the duodenal wall and observed in 15% of the group over 60 years. The peri-Vaterian diverticulum gives little influence to the pancreatico-biliary system except for dilatation of the choledocho-pancreatic duct.
3. The promontory was absent in 30% of the materials regardless the age. The promontory may be classified into two types; complete and incomplete types. Ratio of the complete to incomplete type increased with advancing ages. Histologically no apparent relationship between the promontory and pancreatico-biliary system was observed.

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