A 57-year-old patient with repeated hospitalizations for epigastric pain accompanied by minimal elevations of amylase.
The patient was diagnosed with prostatic adenoma.
She complained of epigastric pain and abdominal discomfort during meals, which forced her to stop eating.
Three times the patient came to the emergency department.
There was only a slight increase in amylase (155 IU, normal < 100).
To attempt to reach a diagnosis, transcutaneous abdominal ultrasound, gastroscopy, and abdominal CT were performed.
All tests were normal.
Finally, magnetic resonance cholangiopancreatography (MRCP) was performed.
It was only observed that the common bile duct and Wirsung were separated into the duodenal wall.
Initially it was interpreted as a variant of normality that can appear in up to 24% normal subjects (1).
However, in view of the invalidation of the symptoms (the patient reported epigastric pain with all meals) he was proposed to realise an endoscopic retrograde cholangiopancreatography (ERCP).
There was a history of allergy to contrast agents and prophylaxis with glucocorticoids was performed.
In the endoscopic image, the papilla presented an appearance obsccid.
The biliary tract was deeply cannulated and a guide wire of 25 inches was created to ensure access to the common bile duct.
Contrast was introduced for cholangiopancreatography from the same papillary orifice.
During the injection the papilla presented a visible distortion in the endoscopic image and appeared as a cystic structure in the cholangiography.
The Wirsung was also drawn during contrast injection, but was immediately tapered and was not reflected on the radiographs.
Chococele diagnosis was made and it was proceeded to seccion by biliary sphincterotomy.
The patient had no complications of endoscopic intervention and pain during ingestion has not reappeared after two years of follow-up.
