TWO ANOMALOUS FOEMS OF DUODENAL POUCHES. 

 By H. D. EOLLESTON, M.D., F.E.C.P., Physician to St 

 Georges Hospital, and W. J. Fenton, M.B., M.E.C.P., 



Curator of the Museum, St Georges Hospital. 



The occurrence of duodenal pouches at the entrance of the 

 common bile duct and pancreatic duct is a well known develop- 

 mental abnormality. The constant position of these duodenal 

 pouches strongly suggests that their occurrence depends on the 

 hepatic diverticulum weakening the wall of the duodenum at 

 its point of departure, and thus allowing a pouching to take 

 place. 



We desire to put on record two unusual forms of duodenal 



pouches. 



I. Bifid Duodenal Pouch. 



In the first case the duodenal pouch is in its usual position, 

 namely, immediately above the biliary papilla ; but the pouch 

 is completely divided into two by a fold of mucous membrane, 

 which covers over the common bile duct on its way to the biliary 

 papilla. In ordinary duodenal pouches, the common bile duct 

 runs along under the floor of the pouch. In the present instance 

 it is on a level with the mucous membrane of the duodenum 

 around the pouch, and has lifted up the mucous membrane 

 covering it, so as to divide completely what probably was at 

 one time a single pouch into two distinct diverticula. The 

 orifices of these two pouches are of the same size, \ inch in 

 diameter, and are well seen in fig. 1, 



The two poaches were embedded in the head of the pancreas, 

 and surrounded by loose connective tissue. When viewed ex- 

 ternally, they appear quite distinct {vide fig. 2), 



The walls of the pouches are very thin. Microscopic sections 

 cut in paraffin only showed mucous membrane. 



The common bile duct and Wirsung's duct open separately 

 •on the top of a papilla ; there is no ampulla of Vater. In their 



