The papilla of Vater just below the pylorus presenting as recurrent duodenal ulcer bleeding.
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.
Sung
Hye Young
HY
Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul.
Kim
Jin Il
JI
Park
Yong Bum
YB
Cheung
Dae Young
DY
Cho
Se Hyun
SH
Park
Soo-Heon
SH
Han
Joon-Yeol
JY
Kim
Jae Kwang
JK
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
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D004952:Esters; D006146:Guanidines; D011480:Protease Inhibitors; C034532:camostat; D064750:Rabeprazole; D016670:Gabexate