Ectopic distal location of the papilla of Vater in congenital biliary dilatation: Implications for pathogenesis

Background/Purpose: This study investigates the relationship between the lo cation of the papilla of Vater and the length of the common channel in pati ents with congenital biliary dilatation (CBD). Methods: Cholangiograms from 121 CBD patients and 13 normal controls were t he subjects for this study. A length index defined as the length of the com mon channel divided by the height of the second lumbar vertebra was used fo r standardization. Results. In the controls, the papilla of Vater was located in the middle of the descending or second part of the duodenum in all cases. In 39 (32.2%) of the 121 CBD patients papilla of Vater was located in the descending duod enum (group I), and in 82 (67.8%) it was distal to the descending duodenum (group II). The average length index of the common channel in group II was significantly longer than in group I (1.123 +/- 0.374 v 0.660 +/- 0.246; P <.001). Findings for the common bite duct were similar. Conclusions: There is a significantly higher incidence of ectopic distal lo cation of the papilla of Vater in CBD patients than in controls. The more d istal the location of the papilla of Vater, the longer the common bile duct and the common channel. J Pediatr Surg 36:1617-1622. Copyright (C) 2001 by W.B. Saunders Company.