50 fresh materials of dissected duodenum and 302 clinical cases of X-ray films showing papilla Vateri were utilized to know the pathological findings at the portion. The results are as follows.
1. The papilla, clinically defined, should include the neighbouring longitudinal fold, as well as the anatomical duodenal papilla.
2. Radiographically the papilla had a variety of forms and it was classified into five fundamental types in view of the variation in the longitudinal fold and the common duct opening.
3. Through this classification a correlation was shown between the type of papilla and the form of opening or the incident angle, of bile and pancreatic duct.
4. The papilla was abnormal if its diameter was longitudinally bigger than 15mm in type 1, bigger than 8mm and 13mm, in type II and III respectively. The transverse diameter in these cases tended to be longer than 7mm.
5. The abnormal papilla was encountered in the bile duct and pancreatic diseases, especially in choledocholithiasis, cholecystitis without stone and postcholecystectomy syndrome.
6. The maximum diameter of bile duct was broadened in the case of abnormal papilla and its terminal portion was radiographically strictured, thus Vaterian bile duct became longer than in the normal case.
7. Histological finding of the abnormal papilla was suggestive of proliferation of connective tissue there.
8. The abnormal papilla may possibly be the X-ray expression of papillitis.
9. The X-ray finding of herniated stone at the papilla enabled us to make correct diagnosis by its specific feature.
10. To diagnose the cancer of ampulla region radiographically, the understanding of the fundamental types of papilla and its strict expression and careful reading are imperative, as well as the consideration of size and form of the papilla.
View full abstract