Abstract
A total of 432 patients with gallstone disease were studied with respect to the existence of juxtapapillary duodenal diverticula and their relationship to the presence of bacteria in the bile. A total of 63 patients were found to have diverticula with an incidence of 14.6 per cent, being significantly higher in the elderly group aged 60 years or older (p<0.01), and no sex difference was noted. Among the patients with diverticula, positive bacterial cultures of bile were recognized at a significantly higher frequency, being found in 49 of the 63 patients (77.8 per cent; p<0.01), and the probability of bilirubinate stones was also higher, being found in 35 of 37 patients (94.6 per cent; p<0.01). The presence of a diverticulum bore significant relation to a higher positive bile bacterial culture (p<0.05), dilatation of the common bile duct (p<0.05), and elevation of the bile duct pressure (p<0.05), even when the conditions were divided into cholecystolithiasis or choledocholithiasis. It was suggested that the presence of a diverticulum affected the flow in the bile duct by narrowing it from the outside and chronically stimulating the papilla, inducing biliary tract infection and/or the formation of gallstones. As the surgical procedures for juxtapapillary duodenal diverticula, including its indications, have not been established, long term follow up investigations seem necessary.
Similar content being viewed by others
References
Lotveit T, Osnes M. Duodenal diverticula. Scand J Gastroent 1980; 19: 579–581.
Kirk AP, Summerfield JA. Incidence and significance of juxtapapillary diverticulum at endoscopic retrograde cholangiopancreatography. Digestion 1980; 20: 31–35.
Osnes M, Myren J, Lotveit T. Juxtapapillary duodenal diverticula and abnormalities by endoscopic retrograde cholangiopancreatography (ERCP). Scand J Gastroent 1977; 12: 347–351.
Thomas E, Reddy KR. Cholangitis and pancreatitis due to a juxtapapillary duodenal diverticulum. Amer J Gastroent 1982; 77: 303–304.
Wilk PJ, Mollura J, Danese CA. Jaundice and pancreatitis caused by a duodenal diverticulum. Amer J Gastroent 1973; 60: 273–279.
Landor JH, Fulkerson CC. Duodenal diverticula. Arch Surg 1966; 93: 182–188.
Leinkram C, Roberts-Thompson IC, Kune GA. Juxtapapillary duodenal diverticula. Med J Austral 1980; 1: 209–210.
Shemesh E, Friedman E, Czerniak A, Bat L. The association of biliary and pancreatic anomalies with periampullary duodenal diverticula. Arch Surg 1987; 122: 1055–1057.
Osnes M, Lotveit T, Larsen S. Anune S. Duodenal diverticula and their relationship to age, sex, and biliary calculi. Scand J Gastroent 1981; 16: 103–107.
Kennedy RH, Thompson MH. Are duodenal diverticula associated with choledocholithiasis? Gut 1988; 29: 1003–1006.
Eggert A. Interdigestive Motilitaet bai Duodenaldivertikeln. Langenbecks Arch Chir 1988; 373: 97–103.
Shemesh E, Czerniak A, Bar-El J, Schneabaum S, Bat L. Choledocholithiasis: A comparison between the clinical presentation of multiple and solitary stones in the common bile duct. Amer J Gastroent 1989; 84: 1055–1059.
Solhaug JH, Semb BKH. Duodenal diverticulum with intermittent biliary stasis. Acta Cir Scand 1974; 140: 670–673.
Delikaris PG, Michail PO, Klonis GD, Haritopoulos NC, Golematis BC, Dreiling DA. Biliary bacteriology based on intraoperative bile culture. Amer Coll Gastroent 1977; 68: 51–55.
Mason RG. Bacteriology and antibiotic selection in biliary tract surgery. Arch Surg 1968; 97: 533–537.
Lotveit T, Osnes M, Anune S, Larsen S. Studies of the choledocho-duodenal sphincter in patients with and without juxtapapillary duodenal diverticula. Scand J Gastroent 1980; 15: 875–880.
Funch-Jensen P, Csendes A, Kruse A, Oester MJ. Common bile duct pressure and Oddi sphincter pressure in patients with common bile duct stones with and without juxta-ampullar diverticula of the duodenum. Scan J Gastroent 1979; 14: 253–256.
Suzuki N, Yamauchi H, Takahashi W, Sato T. Peripapillary duodenal diverticulum and biliary tract disease. Jpn J Surg 1984; 14: 479–485.
Lotveit T, Foss OP, Osnes M. Biliary pigment and cholesterol calculi in patients with and without juxtapapillary duodenal diverticula. Scan J Gastroent 1981; 16: 241–244.
Dineen P. The importance of the route of infection in experimental biliary tract obstruction. Surg Gynec Obstet 1964 119: 1001–1008.
Pinotti HW, Tacla M, Pontes JF, Bettarello A. Surgical procedures upon juxtaampullary duodenal diverticula. Surg Gynec Obstet 1972; 135: 11–16.
Iida F. Transduodenal diverticulectomy for periampullar diverticula. World J Surg 1979; 3: 103–106.
Neil SA, Thompson NW. The complications of duodenal diverticula and their management. Surg Gynecol Obstet 1965; 120: 1251–1258.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shinagawa, N., Fukui, T., Mashita, K. et al. The relationship between juxtapapillary duodenal diverticula and the presence of bacteria in the bile. The Japanese Journal of Surgery 21, 284–291 (1991). https://doi.org/10.1007/BF02470948
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02470948