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October 11, 1930


Author Affiliations

Fellow in Surgery, the Mayo Foundation ROCHESTER, MINN.
From the Mayo Clinic.

JAMA. 1930;95(15):1061-1064. doi:10.1001/jama.1930.02720150001001

The bile in passing from the liver to the intestine passes through a duct of more or less uniform diameter, which is suddenly narrowed at the point where it enters the duodenum at the papilla of Vater. Anatomically a stone would be most likely to meet resistance at this point in its passage down the common bile duct. Likewise at this point the flow of bile would be most easily obstructed. The average diameter of the opening at the tip of the papilla is about 3.5 mm. Just proximal to this opening is found the dilated pouch, approximately 1 cm. in diameter, into which the common bile duct and pancreatic duct usually empty. This is the so-called diverticulum or ampulla of Vater. Fenger, many years ago, described the symptoms of stone lodged in the ampulla, the "ball-valve stone of Fenger." Because a stone at this point causes a somewhat characteristic

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