the common bile duct enters the duodenum at the pylorus.
the common bile duct enters the duodenum at the pylorus.
where does the common bile duct enter the duodenum?
the pylorus
the pancreatic duct and common bile duct enter the descending duodenum, through the major duodenal papilla. the second part of the duodenum also contains the minor duodenal papilla, the entrance for the accessory pancreatic duct. the junction between the embryological foregut and midgut lies just below the major duodenal papilla.









































section::::structure.:third part.
duodenum
endoscopic retrograde cholangiopancreatography (ercp) is the most common approach in unblocking the bile duct. this involves endoscopy (passing a fiberoptic tube through the stomach into the duodenum), identification of the ampulla of vater and insertion of a small tube into the bile duct. a sphincterotomy (making a cut in the sphincter of oddi) is typically done to ease the flow of bile from the duct and to allow insertion of instruments to extract gallstones that are obstructing the common bile duct; alternatively or additionally, the common bile duct orifice can be dilated with a balloon. stones may be removed either by direct suction or by using various instruments, including balloons and baskets to trawl the bile duct in order to pull stones into the duodenum. obstructions that are caused by larger stones may require the use of an instrument known as a mechanical lithotriptor in order to crush the stone prior to removal. obstructing stones that are too large to be removed or broken mechanically by ercp may be managed by extracorporeal shock wave lithotripsy. this technique uses acoustic shock waves administered outside the body to break down the stones. an alternative technique to remove very large obstructing stones is electrohydraulic lithotripsy, where a small endoscope known as a cholangioscope is inserted by ercp to directly visualize the stone. a probe uses electricity to generate shock waves that break down the obstructing stone. rarely, surgical exploration of the common bile duct (termed choledochotomy), which can be performed with laparoscopy, is required to remove the stone.
ascending cholangitis