Anomalous biliary and pancreatic duct insertion into duodenal diverticula.

Over a period of three years, anomalous insertion of the common bile duct and pancreatic duct into a duodenal diverticulum was observed in roughly 3% of all carefully performed T-tube cholangiograms. This would indicate that the lesion is relatively common and should be sought carefully. In this series, the association between the anomalous ductal insertion and biliary tract disease cannot be established, since the method of patient selection obviates any epidemiologic consideration. Of greatest significance is the fact that the anomaly can occur with several anatomic variations. Because of the multiple possible variations, careful radiographic evaluations of the biliary and pancreatic ductal system should be performed before any definitive surgery is directed toward a duodenal diverticulum.