Surgery shows complications during biliary cannulation in a patient with an ectopic papilla, suggesting new therapeutic strategies may be needed.
A 63-year-old man with choledocholithiasis underwent endoscopic retrograde cholangiopancreatography (ERCP). Intraoperatively, the major duodenal papilla was located within a large juxtapapillary diverticulum. Diverticular traction rendered the papilla highly mobile, resulting in substantial difficulty with biliary cannulation. An attempt to stabilize the papilla by applying a clip to the diverticular ridge was unsuccessful ([Fig. 1] a, b).
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