periampullary

Periampullary refers to the region surrounding the ampulla of Vater, the confluence where the common bile duct and main pancreatic duct drain into the second portion of the duodenum through the major duodenal papilla. The periampullary area includes the distal bile duct, pancreatic head and peri-pancreatic tissue, the medial aspect of the duodenum, and nearby structures.

Anatomically, the ampulla sits within the posteromedial wall of the second portion of the duodenum at the opening of the major papilla; the sphincter of Oddi regulates flow from the common bile duct and pancreatic duct. The pancreatic head and lower common bile duct commonly border the periampullary region, which also lies near the duodenal wall and surrounding soft tissues.

Clinical significance in this region centers on periampullary lesions, a heterogeneous group of neoplasms arising around the ampulla. These include ampullary carcinoma, pancreatic head carcinoma, distal common bile duct carcinoma, and periampullary duodenal cancers. Symptoms often include jaundice and pruritus, abdominal pain, and weight loss; complications can include biliary obstruction, cholangitis, and pancreatitis. Imaging and endoscopic evaluation aid diagnosis and staging.

Diagnosis and treatment typically involve跨 imaging (computed tomography, magnetic resonance imaging with MRCP, ERCP, and endoscopic ultrasound) with biopsies when feasible. Management depends on pathology and resectability; resectable periampullary tumors are often treated with pancreaticoduodenectomy (Whipple procedure). Palliative biliary stenting may be employed for unresectable cases, and benign conditions such as stones or diverticula are managed accordingly.

Periampullary diverticulum is a common anatomic variant near the ampulla and can complicate endoscopic procedures.