Atlas of Gastroenterological Endoscopy
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Papilla in an afferent loop after BII surgery
papilla, retrograde view biliary duct in BII-stomach
The major duodenal papilla is approached from aboral in patients with Billroth II gastrojejunostomy via the afferent loop. The location is usually 3-5 cm prior to the dead end of the loop. The duodenoscope is positioned in a "U" shape manner. The picture shows a tumor infiltration by an advanced cancer of the pancreatic head. Surprisingly there was no congestion of the pancreatic duct, which might be a hint towards a carcinoma of acinar cell origin.
papilla retrograde view In this picture the plica horizontalis is clearly seen upside down. See also Normal appearance.