A 40-year-old woman, born in the Philippines, who had returned from her country 15 days before, was admitted for acute pancreatitis.
He had leukocytosis with bilirubin hypertransaminasemia mild (< 90 mg/dl) and normal.
Abdominal ultrasound showed a distended gallbladder with thickened walls and a hyperechoic elongated structure with spontaneous undulating movements.
It extended through the main bile duct from the gallbladder to the papilla.
Associated with this finding, endoscopic retrograde cholangiopancreatography (ERCP) was performed 24 hours later to remove the medication.
However, the papilla was scratched and was not observed.
A new ultrasound and a magnetic cholangioresonance confirmed the absence of bile duct stenosis.
The patient was discharged and admitted favorably.
