title: The papilla of Vater just below the pylorus presenting as recurrent duodenal ulcer bleeding.
abstract: The papilla of Vater emptying into the duodenal bulb site is extremely rare and considered an aberrant condition. We report here a case with recurrent duodenal ulcer bleeding associated with this anomaly. A 42-year-old man was admitted to St. Mary Hospital because of tarry stool for three days. Despite no documented etiology to explain recurrent ulceration, the patient had about ten episodes of ulcer bleeding since 1995. On duodenoscopy, 1.0 x 0.6 cm sized active stage duodenal ulcer with oozing was observed at the posterior wall side below the pylorus. The papilla of Vater was bulging just below the pylorus. Bile juice was excreted from its opening. Pancreatic duct and common bile duct, which drained into the bulb site, were observed on ERCP. In this report, we show that recurrent duodenal ulcer can be associated with the papilla of Vater just below the pylorus.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul.
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Sung
authors.forename: Jin Il
authors.initials: JI
authors.lastname: Kim
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Park
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Cheung
authors.forename: Se Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Soo-Heon
authors.initials: SH
authors.lastname: Park
authors.forename: Joon-Yeol
authors.initials: JY
authors.lastname: Han
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Kim
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001646:Bile / Q000187:drug effects / Q000502:physiology; D001652:Bile Ducts / Q000002:abnormalities; D004381:Duodenal Ulcer / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D004386:Duodenum / Q000002:abnormalities*; D004952:Esters; D016670:Gabexate / Q000031:analogs & derivatives / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006146:Guanidines; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts / Q000002:abnormalities; D010189:Pancreatic Juice / Q000187:drug effects / Q000502:physiology; D011480:Protease Inhibitors / Q000627:therapeutic use; D064750:Rabeprazole
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D004952:Esters; D006146:Guanidines; D011480:Protease Inhibitors; C034532:camostat; D064750:Rabeprazole; D016670:Gabexate