The hepatopancreatic ampulla (ampulla of Vater) is the short dilated channel formed where the common bile duct and the main pancreatic duct join inside the wall of the descending duodenum. It opens at the tip of the major duodenal papilla. Its flow is controlled by the smooth muscle of the sphincter of Oddi.
| Location | Within the wall of the descending part of the duodenum, opening at the major duodenal papilla |
|---|---|
| Parts |
|
| Nerve Supply | Vagus nerve; Coeliac plexus |
| Blood Supply | Anterior and posterior superior pancreaticoduodenal arteries; Inferior pancreaticoduodenal arteries |
| Venous drainage |
|
| Lymphatic drainage |
|
Delivers mixed bile and pancreatic juice into the duodenum and, with its sphincter, prevents duodenal reflux into the ducts.
A stone lodged here can block both bile and pancreatic juice, causing gallstone pancreatitis and jaundice together. Cancers of the ampulla cause painless jaundice early and therefore have a better outlook than pancreatic head cancer; they are treated by pancreaticoduodenectomy. An abnormally long common channel above the duodenal wall is linked to choledochal cysts and gallbladder cancer.
Acute pancreatitis triggered by a stone blocking the ampulla and causing reflux or obstruction of pancreatic juice.
Adenocarcinoma of the ampulla presenting with painless jaundice, sometimes with intermittent bleeding, treated by Whipple resection.
Congenital union of the bile and pancreatic ducts outside the duodenal wall, allowing reflux of pancreatic juice into the bile ducts.
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