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Dual Ampullary Orifices: A Forgotten Embryologic Anomaly in Modern ERCP
Pankaj Gupta1, Pankaj Singh1, Vikas Singla1
1Institute of Liver and Gastrointestinal Sciences, Max Superspeciality Hospital, New Delhi, India.
ACG Case Reports Journal
|April 27, 2026
Summary
Anatomical variations of the ampulla of Vater, such as a rare double major papilla, can lead to dual bile and pancreatic duct orifices. Early recognition prevents inadvertent pancreatic duct cannulation during procedures.
Area of Science:
- Gastroenterology
- Anatomical Pathology
- Embryology
Background:
- The ampulla of Vater typically features a single orifice where the bile and pancreatic ducts join.
- Anatomical variations can arise from abnormal embryogenesis of the hepatopancreatic ducts.
- A double major papilla with dual orifices is an exceedingly rare variation.
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