Fig. 3

Acute reversible duodenitis following ERCP. A 78-year-old male with common bile duct (CBD) carcinoma causing concentric stenosis of the proximal choledochus suffered from acute diffuse abdominal pain without peritonitis 24 h after ERCP including cytological brushing and positioning of a 10-French plastic biliary stent. Urgent contrast-enhanced CT (a, b) showed a correctly placed biliary stent, appearance of moderate ascites (*) and of marked circumferential thickening of the duodenum from the Vaterian papilla to the Treitz angle, with enhancing mucosa and hypoattenuating oedematous submucosa (“target sign”, thin arrows), and minimal associated inflammatory changes in the periduodenal fat. Imaging findings, laboratory data and the subsequent course excluded iatrogenic pancreatitis, haemorrhage and DP. Three weeks later, the plastic biliary stent was removed and replaced with a self-expanding metal stent (SEMS). Follow-up CT (d) showed imaging resolution of both biliary obstruction and acute duodenal inflammatory changes [partly reprinted from Ref. 20]