Obstructive jaundice, epigastric pain and elevated pancreatic enzymes ? biliary pancreatitis.
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Mild dilatation of CBD (1cm) and central intrahepatic biliary ducts with smoothly tapered distal third CBD and enlarged papilla showing submucosal edema in absence of distal stone or any other obstacle. No suspect ampullary or peri-ampullary masses.
The pancreas shows diffuse enlargement with thickening and edema of the lateroconal fascia and left pararenal fat stranding, associated with minimal para-renal fluid. No definite pancreatic masses; the pancreatic duct is not dilated. No peri-pancreatic collections.
The gallbladder shows multiple stones.
Features are suggestive of acute pancreatitis, the associated calcular gallbladder raises the possibility of biliary origin. Mild biliary dilatation (intra and extrahepatic), with enlarged and bulging duodenal papilla showing submucosal edema giving target appearance consistent with acute duodenal papillitis. It could be attributed to post-stone passage.
Acute duodenal papillitis has different underlying etiologies, acute pancreatitis, infection, passage of biliary stones, acute cholangitis and parasites. At our case, it could be due to acute pancreatitis or due to the passage of a biliary stone. Also, both conditions could be co-existing due to the recent passage of biliary stone, being one of the commonest etiologies. Symmetric wall thickening with preserved target appearance helps in distinguishing benign papillitis from malignant conditions.