PMC7327874_01
Plain axial CT of the abdomen and pelvis.. Plain axial CT of the abdomen and pelvis demonstrated (A) inflammatory changes around the pancreatic head and large periampullary diverticulum (arrowhead). (B) A coronal slice showing no inflammatory changes around the pancreatic body and tail.
gr1.jpg
PMC7327874_01_gr1.jpg
fig0005
Plain computed tomography of the abdomen and pelvis revealed a periampullary duodenal diverticulum with surrounding inflammatory changes, and we diagnosed acute pancreatitis and cholangitis (Fig. 1).
Contrast-enhanced axial and coronal CT of the abdomen and pelvis.. Contrast-enhanced CT demonstrated (A) slight dilation of the CBD (arrowhead). (B) A coronal slice showing a large periampullary diverticulum containing fluid with wall thickening, mucosal enhancement, and surrounding inflammatory changes consistent with duodenal diverticulitis (arrowhead).
gr2.jpg
PMC7327874_01_gr2.jpg
fig0010
The next day, contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed slight dilation of the common bile duct (CBD) and a huge periampullary diverticulum containing fluid with wall thickening, mucosal enhancement and surrounding inflammatory changes consistent with duodenal diverticulitis (Fig. 2).
Contrast-enhanced axial CT of the abdomen and pelvis.. Contrast-enhanced CT demonstrated a significant improvement of the inflammation in the pancreatic head (A) and body and tail of the pancreas(B).
gr3.jpg
PMC7327874_01_gr3.jpg
fig0015
One week later, CT revealed a significant improvement of the inflammation (Fig. 3).
ERCP.. ERCP revealed pancreaticobiliary maljunction and a periampullary diverticulum.
gr4.jpg
PMC7327874_01_gr4.jpg
fig0020
Endoscopic retrograde cholangio-pancreatography (ERCP; Fig. 4) and magnetic resonance cholangiopancreatography (MRCP; Fig. 5) revealed pancreaticobiliary maljunction and a periampullary diverticulum.