Major duodenal papilla


The major duodenal papilla is a rounded projection at the opening of the common bile duct and pancreatic duct into the duodenum. The major duodenal papilla is, in most people, the primary mechanism for the secretion of bile and other enzymes that facilitate digestion.

Structure

The major duodenal papilla is situated in the second part of the duodenum, 7–10 cm from the pylorus, at the level of the second or third lumbar vertebrae. It is surrounded by the sphincter of Oddi, and receives a mixture of pancreatic enzymes and bile from the Ampulla of Vater, which drains both the pancreatic duct and biliary system. The junction between the foregut and midgut occurs directly below the major duodenal papilla.
The major duodenal papilla is seen from the duodenum as lying within a mucosal fold. The minor duodenal papilla is situated 2 cm proximal.

Variation

The major duodenal papilla is occasionally found in the third part of the duodenum, the level of the vertebrae may be L2-3, and in about 10% of people, it may not receive bile. Additionally, in a small number of people, the primary papilla for draining the pancreas may in fact be the accessory pancreatic duct.

Clinical significance

The minor papilla drains the duct of Santorini, superior in position to the major papilla. In pancreatic divisum, in which the minor papilla drains the bulk of pancreatic secretions and major drains a minority of secretions, a Santorinicele may develop leading to obstructed secretions/reflux resulting in pancreatitis.

History

The major duodenal papilla was first illustrated by Gottfreid Bidloo in 1685, although is sometimes called the papilla of Vater, after German anatomist Abraham Vater.