The association of biliary and pancreatic anomalies with periampullary duodenal diverticula. Correlation with clinical presentations.

Fifty-eight symptomatic patients with periampullary duodenal diverticula (PDD) were examined for pancreatic and biliary anomalies using endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography, and other imaging modalities. The pathologic findings in these patients were compared with those in a matched group of 58 patients without PDD, who were simultaneously undergoing a similar investigation for the same clinical presentations. Pathologic findings in the pancreas and/or biliary tree were detected in 70.7% of all patients with PDD, compared with 39.7% in the control group. In patients with PDD, pancreatobiliary anomalies were detected in all patients who presented with jaundice, 85% of patients with pancreatitis, and 27.8% of patients with abdominal pain, as compared with 60%, 40%, and 17%, respectively, in the control group. In 23 patients, ERCP findings demonstrated pancreatobiliary abnormalities that were not detected by other imaging modalities. Fifteen of the patients with PDD and pancreatobiliary anomalies had undergone cholecystectomy between six months and five years previously. We conclude that ERCP is essential in the investigation of all patients with PDD, especially those presenting with jaundice or pancreatitis. Biliary surgery in patients with PDD and a dilated bile duct should include a biliary drainage procedure to prevent recurrence of pancreatobiliary disease.