A 73-year-old Japanese man underwent surgery for rectal cancer 1 year earlier, followed by chemotherapy. He presented to our hospital with abrupt-onset, epigastric pain and high fever since the previous day. His vital signs were tachycardia and a fever of 39.2°C. Physical examination revealed no abnormalities other than tenderness in the right hypochondrium. Blood examination revealed leukocytosis, an elevated C-reactive protein level, and liver enzymes. Contrast-enhanced computed tomography of the abdomen showed a stone in the gallbladder and bile duct. He underwent emergency ERCP and a biliary stent was placed. After treatment, he left the hospital. He became the hospitalization for the treatment of the remained stone of bile duct for three months. However, the proximal part of the plastic stent came out through the fistula just above the major papilla. The other part remained the major papilla. The stent was removed endoscopically because no intestinal perforation occurred. Because of the high incidence of serious adverse events, patients with acute cholangitis need prompt treatment in institutions that can provide appropriate emergency care. There are some reports on acute cholangitis due to an accident. However, our case of accidental penetration of the duodenal papilla is very rare.
