Fig. 3. Clinical course after endoscopic retrograde cholangiopancreatography (ERCP). (A) Abdominal pain persisted until day 2 after ERCP, when mild gas distension was observed on abdominal x-ray, but no ileus was detected. (B) Hepatic function was decreased and the total bilirubin level increased; thus, an endoscopic retrograde biliary drainage (ERBD) stent was inserted. (C) On day 4 after the initial ERCP, the patient’s abdominal pain was exacerbated, and computed tomography revealed localized peritonitis with pneumoperitoneum in the retroperitoneum. (D) Distal tip of the endoscopic retrograde pancreatic duct (ERPD) stent located in the left anterior pararenal space (arrow) and high-density fluids near the ERPD stent with multiple air densities (arrowhead).
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