Summary
Periampullary duodenal diverticula are known to be associated with an increased incidence
of common bile duct stones. The nature of the association with gallstones remains
uncertain. We have examined the incidence of periampullary diverticula and stones
after cholecystectomy to determine whether the stones originate primarily in the common
duct or migrate from the gallbladder under the influence of abnormal biliary motility.
Six hundred and forty-one patients undergoing ERCP were studied. Ninety-five patients
had diverticula (14.8 %). Diverticula occurred more commonly in jaundiced patients.
47/95, (48.4 %) than in patients with normal bilirubin 185/546 (33.8 %) (p < 0.01).
Common duct stones were associated with the presence of a diverticulum in 41/95 patients
(43 %), compared with only 98/546 without a diverticulum (18 %) (p < 0.001). There
was no difference in the incidence of common duct stones in association with a diverticulum
between those who had had a cholecystectomy 20/41, and those with intact gallbladders,
21/54 (N.S.). Thus the absence of a gallbladder did not alter the high incidence of
common duct stones. We conclude that the stones in the common duct are most likely
to be primary stones which have formed as a result of periampullary dysfunction.
Key words:
Duodenal diverticula - Common bile duct - Biliary calculi
