Acute pancreatitis due to a papillary obstruction by a vegetable foreign body

Abstract

We report a rare cause of acute pancreatitis due to an obstruction of the pancreatic duct by a vegetable foreign body that was trapped in the papilla of Vater.

A 68-year-old female was referred to the emergency room due to acute epigastric pain. She had no prior medical history. A physical examination showed tenderness in the upper abdominal region. Laboratory analyses showed an elevated C-reactive protein level (300 mg/L, [0.0 – 5.0]) and an elevated lipase level (1176 IU/L, [13 – 60]) without liver function distortion. Computed tomography scan (CT) showed an acute pancreatitis with a mild dilatation of both the pancreatic duct and the common bile duct with an abnormal appearance of the papilla of Vater (Fig. 1). An upper gastrointestinal endoscopy was performed. This showed the esophagus, stomach and duodenal bulb to be normal, but revealed a filamentous vegetable projection to be protruding from a normal papilla of Vater into the second portion of the duodenum. This 7 cm long foreign body was removed by a biopsy forceps (Fig. 2 a,b,c). Afterwards, the patient recovered fast and she could be discharged from the hospital after five days. Exhaustive screening for other causes of acute pancreatitis was satisfying. There was no recurrence of pancreatitis afterwards.

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