The major duodenal papilla is a small rounded elevation on the posteromedial wall of the descending duodenum, about 7-10 cm from the pylorus. It marks the opening of the hepatopancreatic ampulla, through which bile and pancreatic juice enter the duodenum. It is often partly hidden by a hood-like mucosal fold above it.
| Location | Posteromedial wall of the descending part of the duodenum, about 7-10 cm distal to the pylorus |
|---|---|
| Parts |
|
| Nerve Supply | Vagus nerve; Coeliac plexus |
| Blood Supply | Anterior and posterior superior pancreaticoduodenal arteries; Inferior pancreaticoduodenal arteries |
| Venous drainage |
|
| Lymphatic drainage |
|
Delivers bile and pancreatic juice into the duodenum under the control of the sphincter of Oddi.
It is cannulated during ERCP to image and treat the bile and pancreatic ducts, and a sphincterotomy here lets stones be removed. A gallstone stuck at the papilla can cause both obstructive jaundice and acute pancreatitis. Adenomas of the papilla are common in familial adenomatous polyposis and are monitored by endoscopy.
Benign tumour of the papilla with malignant potential, especially in familial adenomatous polyposis, treated by endoscopic or surgical removal.
A stone lodged at the papilla obstructing bile and pancreatic flow, causing jaundice, cholangitis or pancreatitis.
Pancreatic inflammation triggered by instrumentation of the papilla, the most common serious complication of ERCP.
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