Another Cause for Intermittent Jaundice

Elderly lady comes in with recurrent RUQ pain and jaundice. US shows gallstones and a dilated common bile duct. No stones seen in the CBD on MRCP. The GI consultant attempts an ERCP but the common duct cannot be cannulated secondary to a peri-ampullary diverticulum, noted to be full of food matter. I obtain the Upper GI barium study shown above.

Intermittent jaundice has been <>described in association with peri-ampullary duodenal diverticula, although it's quite rare. Options include formally excising the diverticulum versus simply bypassing the distal segment of the CBD with a biliary-enteric anastomosis.

Syndicated from Buckeye surgeon