A 97-year-old woman presented with chief complaints of epigastric pain and vomiting. Computed tomography revealed signs of acute pancreatitis accompanied by two large juxtapapillary diverticula that had compressed on the intrapancreatic portion of the common bile duct (CBD) and the main pancreatic duct along with dilatation of the suprapancreatic portion of the CBD.
Contrast-enhanced computed tomography, abdominal ultrasonography revealed no evidence of choledocholithiasis or tumor. Since the patient's condition did not improve with observational treatments, esophagogastroduodenoscopy was performed on the 4th hospital day. We found that the juxtapapillary diverticula were filled with food residues comprising Shirataki. Most of the food residues were removed, leading to immediate resolution of the symptoms. Furthermore, there was no recurrence of the symptoms during the 18 month follow-up.
This study demonstrated that endoscopic removal of intradiverticular food residues should be considered prior to endoscopic retrograde cholangiopancreatography and surgery.
