Diffuse abdominal pain and jaundice
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There is marked dilatation of the CBD, CHD, right and left hepatic ducts as well as intra hepatic biliary ducts. Moreover there is pancreatic and cystic duct dilatation. CBD and pancreatic ducts give the appearance of double duct sign. There is abrupt tapering at the distal end of the CBD. An ill defined soft tissue mass is noted at the region of the 2nd part of the duodenum which shows proximal dilatation and abrupt change in the caliber. The right kidney shows hydronephrotic changes and signal changes of its parenchyma (nephropathy)
ERCP was done and multiple biopsies were taken from the lesion which later one proved to be periampullary duodenal carcinoma that obstructs the ampulla of Vater causing obstructive jaundice.