When food is digested, it passes from the stomach to the small intestine, then into the large intestine. Along the way, various acids and other substances interact with the food to break it down and make it possible for the body to absorb the nutrients it provides. Both the pancreas and liver connect to the small intestine at the duodenum, adding important substances such as bile, insulin and glucagon to the intestine. The point at which they connect to the intestine, located at the major duodenal papilla halfway along the second half of the duodenum, is called the ampulla of vater.
Also known as the hepatopancreatic ampulla, the ampulla of vater carries bile from the common bile duct, as well as secretions from the pancreas through the pancreatic duct, into the small intestine. Several sphincters ensure the secretions are directed to the right place and prevent the contents of the small intestine from flowing back out through the ampulla. The bile duct and the pancreatic duct both have sphincters to control flow of liquid. Another sphincter, the hepatopancreatic sphincter, controls the movement of liquid through the hepatopancreatic ampulla. This sphincter also is known as the sphincter of Oddi.
One result of secretions not flowing smoothly through the digestive system can be pancreatitis. This disease can occur when the ampulla of vater becomes blocked, such as by a gallstone. When the ampulla of vater is blocked, the digestive juices produced by the pancreas, which include insulin and glucagon, activate within the pancreas instead of in the duodenum. Cells within the pancreas then become irritated, leading to inflammation. Pancreatitis refers to inflammation of the pancreas and can be traced to a variety of other causes as well. Symptoms can include abdominal pain, nausea and pain in the abdomen that spreads to the lower back.
Rarely, cancer can develop in the hepatopancreatic ampulla, with symptoms including jaundice and pain. Like most cancers, early detection leads to a higher possibility of recovery. Fewer than 2,000 cases typically are diagnosed in a year in the United States, and that number constitutes only two-tenths of one percent of all diagnosed gastrointestinal malignancies. This type of cancer occurs in both men and women with equal frequency and is treated by removing the cancer as well as part of the affected duodenum. Cancer of the ampulla of vater often metastasizes into the lymph nodes, and the five-year survival rate is only about 40 percent.
