Reversible acute duodenitis as a complication of endoscopic biliary stenting.

A 78-year-old diabetic male was admitted with jaundice, weight loss, and intermittent upper abdominal pain. Laboratory tests disclosed anaemia (haemoglobin 9.4 mg/dL), elevated C-reactive protein, serum bilirubin (17 mg/dl), transaminase and alkaline phosphatase levels. Following ultrasound confirmation of biliary dilatation, magnetic resonance cholangiopancreatography (MRCP) depicted a concentric stenosis of the proximal common bile duct (CBP) (arrowhead, Fig. 1A), with moderate upstream dilatation of common hepatic duct and intrahepatic branches, suggestive of a neoplastic nature. Endoscopy showed a normal-appearing Vaterian papilla, which was cannulated without the need for sphincterotomy. Contrastmedium injection con rmed the MRCP nding of CBD stricture causing upstream dilatation. After cytological brushing, a 10-cm 10-French plastic biliary stent was positioned, without immediate adverse events. Twenty-four hours later the patient complained of acute di use abdominal pain, without signs of peritonitis at physical examination. Urgent contrast-enhanced multidetector CT (MDCT) showed correctly placed biliary stent, moderate ascites and marked circumferential mural thickening of the duodenum from the papilla to the Treitz angle with strati ed appearance (“target sign”) by enhanced mucosa and hypoattenuated oedematous submucosa (arrows), indicative of mucosal in ammation and oedematous submucosa (Figs. 1B, C), as well as minimal associated perivisceral fat in ammatory changes. Imaging ndings and laboratory data were inconsistent with post-procedural acute pancreatitis, haemorrhage or duodenal perforation. e patient promptly improved with conservative treatment, and jaundice was e ectively relieved. Brush cytology diagnosed CBD adenocarcinoma. Paracentesis uid analysis excluded infection and malignancy. ree weeks later, repeated ERCP showed a normal endoscopic aspect of the duodenum. To achieve long-term tumour palliation, the plastic biliary stent IMAGE OF THE ISSUE