case_images: PMC10613038_01
case_images: Endoscopic retrograde pancreatographic endoscopic findings and magnetic resonance cholangiopancreatography. (A) Endoscopic retrograde pancreatographic and endoscopic findings at our hospital prior to treatment of pancreatolithiasis. The stone (arrowhead) and the pseudocyst (arrow) in the main pancreatic duct are visualized by using endoscopic retrograde pancreatography via the main pancreatic duct (dotted line arrow). A fistula-like opening upon a longitudinal fold above the major duodenal papilla is evident endoscopically (dashed line arrow). (B) Endoscopic retrograde pancreatographic and endoscopic findings after extracorporeal shock wave lithotripsy. Pancreatography (dotted line arrow) shows the main pancreatic duct looping inferiorly toward the major duodenal papilla and giving rise to a branch with an orifice above the major duodenum papilla and the pseudocyst (arrow). Endoscopy demonstrates contrast material emerging from a fistula-like channel in the longitudinal fold above the major duodenal papilla (dashed line arrow). (C) Magnetic resonance cholangiopancreatography before treatment. The common bile duct communicated with the main pancreatic duct (dotted line arrow) and a fistula-like channel opened to the left side of the common bile duct (dashed line arrow).
case_images: goad065f1.jpg
case_images: PMC10613038_01_goad065f1.jpg
case_images: goad065-F1
case_images: The pseudocyst was slightly proximal to the stone (Figure 1A). After endoscopic extraction of the stone fragment, pancreatography showed the main pancreatic duct looping inferiorly toward the major duodenal papilla and giving off a branch leading to an orifice just above the papilla (Figure 1B). These findings represented an anatomic variant of Wirsung duct (Figure 1B).