Published online Feb 16, 2014. doi: 10.12998/wjcc.v2.i2.36
Revised: December 20, 2013
Accepted: January 15, 2014
Published online: February 16, 2014
Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure.
Core tip: Drainage of the main pancreatic and bile duct as two separate orifices is a recognized, but very rare anatomical variant. It is also referred to as double major papillae.