Surgical emphysema of the scrotum--another complication of ERCP?

clinical and biochemical evidence of obstructive jaundice (bilirubin level 52 μmol/l). Abdominal ultrasound and computed tomography (CT) suggested that the level of obstruction was in the region of the ampulla of Vater, with no evidence of metastatic disease. He was subsequently subjected to an endoscopic retrograde cholangiopancreatographic (ERCP) examination with diagnostic and therapeutic intent. This revealed a 2 cm, well-circumscribed lesion of the major ampulla. A papillotomy was done into the pancreatic duct to facilitate biliary cannulation. This produced bile drainage but subsequent attempts at biliary cannulation resulted in submucosal injection of contrast into the duodenal wall, and no further attempts at cannulation were made. The tumour was biopsied and the procedure terminated.