International Journal of Anatomy and Research

eISSN 2321-4287 · pISSN 2321-8967

Volume 14 · Issue 2 · Pages 9490–9495 · June 2026

Research Article

Morphology of the Hepatopancreatic Ampulla by the Injection-radioscopy Method: Anatomical Study and Clinical Applications About 30 Cases

M Ndiaye1*, N J-M Ndoye², Aï Ndiaye², I Thiam³, Cmm Dial⁴, M Kasse⁵, H Deme⁶, Ab Ndiaye²

¹Anatomy and Organogenesis Laboratory of the Assane Seck University of Ziguinchor (UASZ), Senegal.
²Anatomy and Organogenesis Laboratory of the Cheikh Anta Diop University of Dakar (UCAD), Senegal.
³Pathological Anatomy and Cytology Laboratory of the Aristide Le Dantec Hospital (HALD), Dakar, Senegal.
⁴Pathological Anatomy and Cytology Laboratory of the Idrissa Pouye General Hospital (HOGIP), Dakar, Senegal.
⁵Medical Imaging Service of the HOGIP, Dakar, Senegal.
⁶HALD Medical Imaging Service, Dakar, Senegal.

Corresponding author: Dr. Mamadou Ndiaye, Teacher-researcher, Laboratory of Anatomy and Organogenesis/Assane Seck University of Ziguinchor-Senegal; Phone: 00221772645481, E-Mail: mamadou.ndiaye@univ-zig.sn

Received: 02 February 2026 · Revision received: 03 March 2026 · Accepted: 07 May 2026 · Published: 05 June 2026

DOI: 10.16965/ijar.2026.114

Author ORCID iD:
M Ndiaye — https://orcid.org/0009-0007-6826-8002

Abstract

Objective

The purpose of our work was to study the configuration of the hepato-pancreatic junction and to review the literature.

Material and method

It was a fundamental observational study for descriptive purposes. It was about 30 pieces of fresh pancreas taken from anatomical subjects during forensic autopsy. The average age was 39.43 years. The cephalo-isthmic configuration of the pancreatic ducts was studied by the injection-radioscopy method. The mode of constitution of the hepatopancreatic ampulla (AHP) was evaluated based on the Flati classification [1]. The parameters studied were morphological and morphometric.

Results

In 18 cases (60%), there was a 'Ya' type with an average length of 5.4mm of the AHP and an average diameter of 1.6mm. In 1 case (3.3%), we observed a 'Yb' type with a length of 12mm of the AHP and a diameter of 1.9mm. In 2 cases (6.7%), the AHP had the shape of a 'V' with an average length of 0.95mm of the AHP and an average diameter of 0.7mm. In 8 cases (26.7%), the AHP had the shape of a 'U'. In 1 case (3.3%), the AHP had the form of an 'II'.

Conclusion

The anatomical study of the AHP in the population is interesting in the sense that it makes it possible to identify or estimate the groups at risk regarding the occurrence of certain pathologies of the bilio-pancreatic pathways.

Keywords: Pancreatic Ducts; Hepato-Pancreatic Ampoule; Injection-Radioscopy; Flati Classification.

INTRODUCTION

The hepatopancreatic ampulla (HPA) has a complex anatomy related in particular to the different modes of convergence of the choledoc duct (CD) and the main pancreatic duct (MPD) [1,2]. Thus, there are multiple anatomical variants essential to know to prevent certain risks of pathologies of varying severity, ranging from biliary cysts to biliary tract cancers [3].

Indeed, the relationship between the terminal portions of CD and MPD and its variants has long been important in the sense that the reflux of bile, duodenal or pancreatic contents in this ductal system may or may not be possible in certain anatomical circumstances [4-6]. The objective of this study was to describe the configuration of the hepato-pancreatic junction by the radioscopy injection method and to review the literature.

MATERIALS AND METHODS

This is a fundamental observational study for descriptive purposes. It concerned 30 pieces of fresh pancreas taken from anatomical subjects during forensic autopsy (numbered from P1 to P36). The average age was 39.43 years (Standard deviation = 13.9). The sex ratio was 3.3. The average size of the subjects was 175.10 cm [extreme 163cm-187cm]. The average length of the pancreas was 22.48 cm +/- 2.4.

In the laboratory, the transverse length of the pancreas was measured with a tape measure, from the right edge of the head from the middle of the descending portion of the duodenum to the end of the tail. Then the choledoc duct was spotted on the posterior face of the specimen and then catheterized with an intracath of adapted caliber. Subsequently, the pancreas was sectioned sagittally over its entire height using a scalpel at the body-tail junction. The main pancreatic duct was spotted in the section and catheterized.

Then the specimen was sent to the imaging department to take X-ray shots using a versatile digital radio-fluoroscopy device with a tilting table. First of all, a first shot without injection was taken. Then, the contrast agent was injected at constant pressure, under radioscopic control, into the main pancreatic duct (1st step), then into the choledoch (2nd step) and finally both at the same time (3rd step). The intra-pancreatic ducts were spotted until they were dislodged at the duodenal mucosa. When the injection was deemed sufficient, front incidence shots were taken for the different steps. For each preparation, photographs were taken. The assessment of the permeability of the duodenal papillae was judged on the injection clichés.

The cephalo-isthmic configuration of pancreatic ducts was studied. The method of constitution of the hepatopancreatic ampulla was evaluated on the basis of the Flati classification (Figure 1) [1]. The actual dimensions (length and diameter of the AHP) were taken by the ruler at the PACS (Picture Archiving and Communication System). Finally, the anatomical pieces were secondarily sent to the Anatomy and Organogenesis Laboratory. The parameters studied were morphological and morphometric. The data were analyzed by SPSS software version 25.0.

[picture]

Figure 1: Flati classification of the hepatopancreatic ampulla configuration

RESULTS

The different modalities of junction between the choledoc duct and the main pancreatic duct were mainly at the level of a hepatopancreatic ampoule but in a variable way. This hepatopancreatic bulb always opened at the level of a single major duodenal papilla.

In 18 cases (60%), a 'Ya' type was noted with an average length of 5.4mm of the common portion (extremes 1.9mm-9.9mm) and an average diameter of 1.6mm (extremes 1mm-3.2mm) (Figure 2).

[picture]

Figure 2: 'Ya' type of hepatopancreatic ampulla

In 1 case (3.3%), a 'Yb' type was observed with a length of 12mm of the common portion and a diameter of 1.9mm (Figure 3).

[picture]

Figure 3: 'Yb' type of hepatopancreatic ampulla

In 2 cases (6.7%), the hepatopancreatic bulb was shaped like a 'V' with an average length of 0.95mm of the common portion and an average diameter of 0.7mm (Figure 4).

[picture]

Figure 4: 'V' shaped hepatopancreatic ampulla

In 8 cases (26.7%), the hepatopancreatic ampoule had the shape of a 'U' with the main choledoc and pancreatic ducts that opened at the level of the same duodenal papilla without having a common portion (Figure 5).

[picture]

Figure 5: 'U' shaped hepatopancreatic ampulla

In 1 case (3.3%), the hepatopancreatic ampoule had the shape of an 'II' where there was no common portion between the choledocal duct and the main pancreatic duct and a distinct duodenal papilla for each duct (Figure 6).

[picture]

Figure 6: 'II' type with separate duodenal papillae

Table 1: Distribution of the sample according to the Flati Hepatopancreatic ampulla configuration classification.

HPA Configuration (Flati's classification) | Number of cases | Percentage (%)
Ya Type | 18 | 60.0
U Type | 8 | 26.7
V Type | 2 | 6.7
Yb Type | 1 | 3.3
II Type | 1 | 3.3

DISCUSSION

The anterograde injection-radioscopy method is a means of seeing almost all the ramifications of the pancreatic ducts. This method has allowed many authors to provide new data on pancreatic ducts. It is an easily feasible exploration method, already proven for years [7-10]. Indeed, dissection makes it easy to follow the duct that drains the tail and body of the pancreas during its relatively straight path to the head of the pancreas. But it becomes much more difficult to follow the duct, to identify its tributaries and its communications once it has entered the head of the gland.

The rise of endoscopic retrograde pancreatography, as a clinical procedure, has prompted some authors after catheterization of the main choledocal and pancreatic ducts to obtain pancreatograms in post-mortem anatomical subjects. In 1911, Baldwin was already providing convincing results by an injection-radioscopy method rather than the pancreatic duct dissection method [11]. In addition, anterograde injection, giving similar results, is a much more physiological test providing details of the anatomy of pancreatic ducts. Over the years, several classifications of pancreatic ducts have been proposed (Millbourn, Sigfusson, Dawson, Skandalakis, and Flati) [1,10,12,23]. We used the Flati classification because it is recent and applied in comparable series like Wilasrusmee [1,14].

In most cases, the main pancreatic duct joins the choledoc duct to form a common portion before discharging through the same orifice in the second portion of the duodenum, with a clear predominance of the 'Ya' type (60%), consistent with literature. 'Yb' type (common portion > 10 mm) occurred in 3.3% of cases (Flati reported 4%). Long common channels (> 15 mm) are considered pathological and predisposing to congenital choledochal cysts [15-17] and gallbladder carcinoma due to pancreatic juice reflux [18-21]. Type 'U' (separate openings in common papilla) accounted for 26.7% (8 cases), and Type 'II' (separate papillae) accounted for 3.3% (1 case) [22-24].

CONCLUSION

The anatomical study of the hepatopancreatic ampoule in the population is interesting in the sense that it makes it possible to identify or estimate risk groups for the occurrence of certain pathologies of the bilio-pancreatic pathways. These anatomical data have important clinical applications and open up new surgical perspectives, including the prevention of the occurrence of cysts or biliary tract cancer based on early detection of anatomical variants.

ABBREVIATIONS

AHP / HPA

Hepatopancreatic Ampulla (Ampoule Hépato-Pancréatique)

CD

Choledoc Duct / Common Bile Duct

MPD

Main Pancreatic Duct

PACS

Picture Archiving and Communication System

SPSS

Statistical Package for the Social Sciences

ACKNOWLEDGEMENTS

All authors contributed to the writing and proofreading of this manuscript.

DECLARATIONS

Ethics Committee Approval: Approved.

Conflicts of Interests: None.

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