Ampulla of Vater

What is the ampulla of Vater?

The ampulla of Vater is the place where your common bile duct and pancreatic duct empty into your duodenum (first part of your small intestine). Here, bile (from your liver) and enzymes (from your pancreas) merge before entering your duodenum. These substances help to break down the food in your intestine for digestion.

An ampulla is a rounded flask from Roman times. In your body, an ampulla usually describes a pouch-like reservoir where two ducts converge. An anatomist named Abraham Vater first described this ampulla, and it was later named for him. Other names for it include the hepatopancreatic ampulla and the biliopancreatic ampulla.

What is the purpose of the ampulla of Vater?

Your biliary system plays an important role in your digestion. The ampulla of Vater is the place where your biliary tract contributes its digestive juices to your gastrointestinal tract. Bile from your liver and digestive enzymes from your pancreas reach the end of their journey through your bile duct and pancreatic duct and merge here.

Where is the ampulla of Vater located?

The ampulla of Vater is within the wall of your duodenum, which is about 10 inches long. Healthcare providers subdivide the duodenum into four parts. The ampulla of Vater is halfway along the second or “descending” part, about 4 inches in. This is the transition point between your foregut, which breaks down food, and midgut, which absorbs it.

What does the ampulla of Vater look like?

Traditionally, the ampulla of Vater has a bulbous appearance that resembles the spherical Roman flask. The neck of the flask is where the two ducts feed into the wider reservoir. However, this anatomy can vary. In fact, as often as 38% of the time, the two ducts remain distinct, and they empty into your duodenum through a double-barreled opening.

How does the ampulla of Vater work?

The rounded body of the ampulla contains a system of circular muscles (sphincters) that open and close to control the flow of bile and enzymes. Like most of the muscles in your digestive system, these are smooth muscles, which function automatically. They respond to signals from your nervous system. These signals tell the sphincters when to open or close.

What are its parts?

The main parts of the ampulla of Vater include the sphincter of Oddi (the valve system at the entrance) and the papilla of Vater (the opening into your duodenum). Sphincter of Oddi is a composite term for a valve system that includes the sphincter of the pancreatic duct, the sphincters of the bile duct and the sphincter of the ampulla.

• The sphincter of the pancreatic duct (sphincter of Wirsung) controls the flow of enzymes from the pancreatic duct into the ampulla.
• The two sphincters of the bile duct (of choledochus) work together to control the flow of bile into your duodenum. The one that’s higher up is called the superior sphincter or sphincter of Boyden. The lower one is called the inferior sphincter.
• The sphincter of the ampulla (hepatopancreatic sphincter) controls the release of bile and enzymes from the ampulla into your duodenum.
• The papilla of Vater (major duodenal papilla) is the external opening of the ampulla into the inside of your duodenum (the lumen).

What diseases or disorders can affect the ampulla of Vater?

Conditions that can affect the ampulla of Vater include:

• Adenoma: An adenoma is an abnormal growth that isn’t cancer but carries a risk of developing into cancer. It usually doesn’t cause symptoms, but if it grows, it can block the flow of bile and enzymes, causing complications.
• Ampullary cancer: Rarely, an ampullary adenoma can turn into cancer (carcinoma). This cancer can grow and spread aggressively, so surgery is generally required to remove it.
• Sphincter of Oddi dysfunction. This means your sphincter of Oddi doesn’t open when it should to let digestive juices out. The juices back up inside your biliary or pancreatic system, causing complications.
• Obstruction. If there’s a blockage in your ampulla, this can also cause fluids to back up in your bile ducts. Gallstones are the most common obstruction, but sometimes, scar tissue causes it.

What symptoms might suggest a problem in my ampulla of Vater?

If a tumor, gallstone or other issue in your ampulla of Vater prevents bile and enzymes from passing through it, the blockage can cause your whole biliary system to back up. This causes symptoms like:

• Abdominal pain
• Biliary colic
• Jaundice
• Nausea and vomiting

An obstruction in your biliary system can happen anywhere. Your ampulla of Vater is just one place your healthcare provider will look for it. Wherever it occurs, the obstruction affects the whole system.

How do healthcare providers examine or treat my ampulla of Vater?

Healthcare providers can often examine and treat your ampulla of Vater through endoscopy, without the need for surgery. They do this by passing a tiny camera on the end of a thin tube down your throat and all the way into your duodenum. They can pass tools through the endoscope to remove tumors and relieve obstructions. This procedure is called ERCP (endoscopic retrograde cholangiopancreatography).