Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2021; 9(14): 3379-3384
Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3379
Acute cholangitis detected ectopic ampulla of Vater in the antrum incidentally: A case report
Hsu-Lin Lee, Chun-Kai Fu
Hsu-Lin Lee, Chun-Kai Fu, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 411, Taiwan
Hsu-Lin Lee, Chun-Kai Fu, Department of Internal Medicine, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Fu CK and Lee HL were the patient’s physicians; Lee HL collected the data and wrote the manuscript; Fu CK revised the manuscript; All authors approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chun-Kai Fu, MD, Chief Doctor, Department of Internal Medicine, Taichung Armed Forces General Hospital, No. 348 Sec. 2 Zhongshan Rd., Taichung 411, Taiwan. gr1027@livemail.tw
Received: November 9, 2020
Peer-review started: November 9, 2020
First decision: February 12, 2021
Revised: February 22, 2021
Accepted: March 12, 2021
Article in press: March 12, 2021
Published online: May 16, 2021
Processing time: 167 Days and 20.8 Hours
Abstract
BACKGROUND

The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct. It is located in the second portion of the duodenum. An ectopic papilla of Vater is an anomalous termination. Few cases have been reported. We report the rare case of a man with an ectopic ampulla of Vater in the pylorus.

CASE SUMMARY

An 82-year-old man had experienced abdominal pain and fever with chills 1 d before his presentation. A computed tomography scan of the abdomen demonstrated dilatation of the common bile duct approximately 2.2 cm in width. Gas retention was found in his intrahepatic ducts. Acute cholangitis with pneumobilia was identified, and he was hospitalized. Esophagogastroduo-denoscopy and endoscopic retrograde cholangiopancreatography disclosed no ampulla of Vater in the second portion of the duodenum. Moreover, a capsule-like foreign body (pharmaceutical desiccant) approximately 1 cm × 2 cm in size was found at the gastric antrum and peri-pyloric region. After the foreign body was removed, one orifice presented over the pyloric ring in the stomach, a suspected ectopic ampulla of Vater. Subsequently, sludge in the common bile duct was cleaned, and balloon dilatation was performed. The general condition improved daily. The patient was discharged in a stable condition and followed in our outpatient department.

CONCLUSION

This case involved an ampulla of Vater in an unusual location. Endoscopic retrograde cholangiopancreatography with balloon dilatation is the main treatment recommended and performed.

Keywords: Ectopic papilla of Vater; Ectopic ampulla of Vater; Pneumobilia; Endoscopic retrograde cholangiopancreatography; Acute cholangitis; Case report

Core Tip: Ectopic papilla of Vater is scarcely reported. Potential locations of ectopic papilla are the stomach, pyloric canal, duodenal bulb, or third or fourth portion of the duodenum. Anomalous termination in the stomach is rare. Although this anatomy may mislead endoscopic retrograde cholangiopancreatography operators, this nonetheless constitutes a safe and common therapeutic procedure. When no ampulla of Vater is detected in the second portion of the duodenum, ectopic papilla of Vater should be considered.