Ampulla of Vater

Not to be confused with Duodenal ampulla.

Ampulla of Vater
A diagram of the biliary system. Note that the ampulla of Vater is behind the major duodenal papilla.
The major duodenal papilla, seen on duodenoscopy at the time of ERCP. This is the protrusion of the ampulla of Vater into the duodenum.
Details
Identifiers
Latin	ampulla hepatopancreatica, ampulla Vaterii
MeSH	D014670
TA98	A05.8.02.017
TA2	3111
FMA	15076
Anatomical terminology [ edit on Wikidata]

The ampulla of Vater, hepatopancreatic ampulla or hepatopancreatic duct is the common duct that is usually formed by a union of the common bile duct and the pancreatic duct within the wall of the duodenum. This common duct usually features a dilation ("ampulla"). The common duct then opens medially into the descending part of the duodenum at the major duodenal papilla. The common duct usually measures 2–10mm in length. ^[1]

The ampulla of Vater is an important landmark halfway along the second part of the duodenum marking the transition from foregut to midgut.^{[ citation needed ]}

Structure

1. Bile ducts :
      2. Intrahepatic bile ducts
      3. Left and right hepatic ducts
      4. Common hepatic duct
      5. Cystic duct
      6. Common bile duct
      7. Ampulla of Vater
      8. Major duodenal papilla
9. Gallbladder
10–11. Right and left lobes of liver
12. Spleen
13. Esophagus
14. Stomach
15. Pancreas :
      16. Accessory pancreatic duct
      17. Pancreatic duct
18. Small intestine :
      19. Duodenum
      20. Jejunum
21–22. Right and left kidneys
The front border of the liver has been lifted up (brown arrow).

Sphincters

Various smooth muscle sphincters regulate the flow of bile and pancreatic juice through the ampulla: the sphincter of the pancreatic duct, the sphincter of the bile duct, and the sphincter of Oddi. ^[3]

Variation

The common bile duct and pancreatic duct may sometimes unite outside the duodenal wall, creating an unusually long common duct. The two ducts may also drain into the duodenum separately, or may fuse yet retain their separate lumens separated by a septum. ^[1]

Clinical significance

Thomas' sign is the production of silver stools and can be indicative of cancer of the Ampulla of Vater. The ampulla of Vater is the site of tumors, often with a threatening prognosis and difficult surgical treatment. The silver-colored stool is a combination of the white stool of obstructive jaundice combined with black stool of melena or bleeding. It was first described in the British Medical Journal by Dr. H. Ogilvie in 1955. ^[4]

Regarding bowel obstruction in humans, if the obstruction is distal to the ampulla of vater (distal to the second part of the duodenum), vomit may be bilious. This is particularly useful in the realms of paediatrics to distinguish more proximal causes such as pyloric stenosis, from bilious causes such as malrotation. ^[5] Bilious vomit is differentiated by the green (usually dark/leafy) appearance of human bile, occuring after the stomach has been completely emptied.

Etymology

The eponymic term "ampulla of Vater" is named after Abraham Vater (1684–1751), ^[6] a German anatomist who first published a description of it in 1723. ^[7]

Additional images

• 
  The pancreatic duct.
• 
  Carcinoma of Ampulla

References

1. Standring, Susan (2020). Gray's Anatomy: The Anatomical Basis of Clinical Practice (42nd ed.). New York. p. 1219. ISBN   978-0-7020-7707-4. OCLC   1201341621.
2. Standring S, Borley NR, eds. (2008). Gray's anatomy : the anatomical basis of clinical practice. Brown JL, Moore LA (40th ed.). London: Churchill Livingstone. pp. 1163, 1177, 1185–6. ISBN   978-0-8089-2371-8.
3. Allescher, H. D. (1989). "Papilla of Vater: Structure and Function". Endoscopy. 21 (S 1): 324–329. doi:10.1055/s-2007-1012982. PMID   2691236. S2CID   38457896. Archived from the original on June 2, 2018. Retrieved March 27, 2020– via www.thieme-connect.de.
4. Ogilvie, H (1955). "Thomas's sign, or the silver stool in cancer of the ampulla of Vater". Br Med J. 1 (4907): 208. doi:10.1136/bmj.1.4907.208. PMC   2060824 . PMID   13219383.
5. "Bilious Vomiting: Management of Term Babies Presenting With Bilious Vomiting". NHS Lothian Neonatal Guidelines. NHS Scotland, Right Decisions Service. 2024. Retrieved January 12, 2026.
6. Lerch, MM; Domschke, W (2000). "Abraham Vater of the ampulla (papilla) of Vater". Gastroenterology. 118 (2): 379. doi: 10.1016/s0016-5085(00)70243-5 . PMID   10691372.
7. Vater A. Dissertation in auguralis medica, poes diss. Qua Scirris viscerum dissert, C.S. Ezlerus. Vol 70. 1723.

• "Ampulla, hepatopancreatic." Stedman's Medical Dictionary, 27th ed. (2000). ISBN   0-683-40007-X
• Moore, Keith L. and Arthur F. Dalley. Clinically Oriented Anatomy, 4th ed. (1999). ISBN   0-683-06141-0