case_images: PMC7136765_01
case_images: Computed tomography scan showing an ill-defined, hypodense mass at the pancreatic head, causing upstream dilatation of the common bile duct (a) and pancreatic duct (b) compatible with the double duct sign.
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case_images: fig1
case_images: A computed tomography scan demonstrated an ill-defined mass at the pancreatic head (4.0 cm x 4.2 cm in size) causing distal common bile duct and pancreatic duct dilatation (Figure 1).
case_images: Cholangiography showing a long-segment stricture at the distal common bile duct. (a) The stricture caused upstream dilatation of the distal common bile duct; (b) after the placement of a fully covered self-expandable metal stent.
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case_images: fig2
case_images: Endoscopic retrograde cholangiography (ERC) was subsequently performed and showed a long-segment stricture at the distal common bile duct that caused upstream dilatation (1.5 cm in diameter, together with dilations of the bilateral intrahepatic ducts; Figure 2(a)). TaeWoong Medical Co, Ltd., Gimposi, Gyeonggi-do, Korea), which facilitated biliary drainage (Figure 2(b)). The patient received palliative chemotherapy, consisting of cycles of a cisplatin and gemcitabine regimen.
case_images: Computed tomography scan performed after the patient developed recurrent obstructive jaundice showing proximal migration of the previously placed metallic stent (a). The distal end of the stent was located above the pancreatic mass (b), and upstream dilatation of the common bile duct was apparent.
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case_images: fig3
case_images: A computed tomography scan demonstrated proximal migration of the previously placed CSEMS (Figure 3), and the patient was scheduled for endoscopic intervention.
case_images: Cholangiography showing proximal migration of the previously placed SEMS. Upstream dilatation of the common bile duct, the common hepatic duct, and bilateral intrahepatic ducts are shown by (a), (b), and (c), respectively.
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case_images: fig4
case_images: In the endoscopy suite, the cholangiogram verified proximal migration and showed upstream dilation of the common bile duct (Figure 4).
case_images: Fluoroscopic view of the stent-in-stent technique applied during the procedure.
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case_images: fig5
case_images: Stent ; TaeWoong Medical Co, Ltd., Gimposi, Gyeonggi-do, Korea) was placed across the stricture site, inside the previous stent. Satisfactory drainage was achieved (Figure 5).