A 61-year-old patient without significant alcohol history presented with epigastric pain of 2 days’ duration, most recently aggravating and radiating into the back. Laboratory analysis indicated acute pancreatitis (ie, serum lipase 1839 U/L; procalcitonin 11.1 ng/mL) as well as moderately elevated liver function tests (ie, bilirubin 1.6 mg/dL). Abdominal ultrasound demonstrated gallbladder stones with normal intrahepatic bile ducts, but the common bile duct could not be properly visualized. Therefore, the patient underwent urgent radial endoscopic ultrasound (EUS) indicating mild edematous pancreatitis in parts of the body and head as well as a formal double-duct sign (Figure A) with stone material visible in the distal and papillary common bile duct segments. Next, an uncomplicated endoscopic retrograde cholangiography (ERC) confirmed papillary stone impaction (Figure B). An endoscopic papillotomy with subsequent stone extraction was performed. The patient took a favorable clinical course, and laparoscopic cholecystectomy was scheduled during the same hospital stay.
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-Vincent Zimmer
This article originally appeared in the July 2019 issue of The American Journal of Medicine.
