An 80-year-old man presented with 3 days of epigastricpain, nausea, and vomiting. He received a diagnosis of mildgallstone pancreatitis based on elevated lipase at 9781 U/L,gallbladder sludge, dilated common bile duct (CBD), andacute elevation of direct bilirubin to 3.3 mg/dL. The patientdenied alcohol use. A CT of the abdomen with intravenouscontrast medium showed a hydropic gallbladder withsludge, dilatation of the CBD to 10 mm, and a pancreaswithout mass lesions or necrosis. The patient underwentERCP 24 hours after initial presentation, given the abovefindings. Unfortunately, during the ERCP an iatrogenicperforation of the lateral wall of the duodenal bulboccurred while the endoscope was being reduced(Fig. 1A, Video 1, available online at www.VideoGIE.org).Antibiotics were initiated.
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机译：一名80岁的男子出现了3天的上腹痛，恶心和呕吐。他因脂肪酶升高（9781 U / L），胆囊污泥，胆总管扩张（CBD）和直接胆红素迅速升高至3.3 mg / dL而被诊断为轻胆石性胰腺炎。拒绝饮酒。腹部CT静脉造影显示胆囊积水，胆囊中央膜扩张至10 mm，胰腺无肿块或坏死。根据上述发现，患者在初次就诊后24小时接受了ERCP治疗。不幸的是，在ERCP手术中，在内窥镜缩小时发生了十二指肠球侧壁的医源性穿孔（图1A，视频1，可从www.VideoGIE.org在线获得）。开始使用抗生素。
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