An 83-year-old man with an 18-month history of a previously assumed benign duodenal stricture and relapsing pancreatitis was transferred from an outside hospital with new-onset obstructive jaundice. His medical history included heart failure, atrial fibrillation for which warfarin was prescribed, and a pacemaker. CT of the abdomen demonstrated biliary and pancreatic duct dilation, multiple peripancreatic lymph nodes, and a possible small lesion in the periampullary area (Fig. 1).
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