Reversed ERCP rendezvous procedure: minor papilla stenting to facilitate main pancreatic duct and common bile duct access through the major papilla

Abstract

A 79-year-old woman was seen for severe midepigastric pain, nausea and vomiting, and elevated amylase (746 U/L [normal 28-100 U/L]) and lipase (2127 U/L [16-63 U/L]) levels. Physical examination revealed exquisite midepigastric tenderness, anicteric sclerae, and absence of jaundice. The total white blood cell count was 13,180/mm3 (4500-11,000/mm3), total bilirubin was 1.2 mg/dL (0.1-1.2 mg/dL), and alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase were elevated to 60 U/L (0-31 U/L), 99 U/L (0-31 U/L), and 92 U/L (30-120 U/L), respectively.