case_images: PMC7327874_01
case_images: Plain axial CT of the abdomen and pelvis.. Plain axial CT of the abdomen and pelvis demonstrated (A) inflammatory changes around the pancreatic head and large periampullary diverticulum (arrowhead). (B) A coronal slice showing no inflammatory changes around the pancreatic body and tail.
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case_images: Plain computed tomography of the abdomen and pelvis revealed a periampullary duodenal diverticulum with surrounding inflammatory changes, and we diagnosed acute pancreatitis and cholangitis (Fig. 1).
case_images: Contrast-enhanced axial and coronal CT of the abdomen and pelvis.. Contrast-enhanced CT demonstrated (A) slight dilation of the CBD (arrowhead). (B) A coronal slice showing a large periampullary diverticulum containing fluid with wall thickening, mucosal enhancement, and surrounding inflammatory changes consistent with duodenal diverticulitis (arrowhead).
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case_images: The next day, contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed slight dilation of the common bile duct (CBD) and a huge periampullary diverticulum containing fluid with wall thickening, mucosal enhancement and surrounding inflammatory changes consistent with duodenal diverticulitis (Fig. 2).
case_images: Contrast-enhanced axial CT of the abdomen and pelvis.. Contrast-enhanced CT demonstrated a significant improvement of the inflammation in the pancreatic head (A) and body and tail of the pancreas(B).
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case_images: One week later, CT revealed a significant improvement of the inflammation (Fig. 3).
case_images: ERCP.. ERCP revealed pancreaticobiliary maljunction and a periampullary diverticulum.
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case_images: Endoscopic retrograde cholangio-pancreatography (ERCP; Fig. 4) and magnetic resonance cholangiopancreatography (MRCP; Fig. 5) revealed pancreaticobiliary maljunction and a periampullary diverticulum.