The relationship between juxtapapillary duodenal diverticula and the presence of bacteria in the bile.

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 less than 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 less than 0.01), and the probability of bilirubinate stones was also higher, being found in 35 of 37 patients (94.6 per cent; p less than 0.01). The presence of a diverticulum bore significant relation to a higher positive bile bacterial culture (p less than 0.05), dilation of the common bile duct (p less than 0.05), and elevation of the bile duct pressure (p less than 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.