LAUSR

re 1. A, CT of the abdomen/pelvis with severe acute pancreatitis, with several peripancreatic gas-containing fluid collections, and periduodenal fluid ctions with air within the collection, suggesting fistula. Decreased pancreatic parenchymal enhancement suggesting pancreatic necrosis; also seen are iple calcifications within the pancreatic head consistent with chronic pancreatitis. B, C, Initial EGD with no bleeding source identified in the esophstomach, or duodenum. B, Normal second part of the duodenum on EGD, with Dobhoff tube visualized. C, Colonoscopic view was also unremarkwith only small internal hemorrhoids visualized. D, E, Repeated EGD after hematochezia revealed a blood clot (D), thought to be overlying the r papilla, at the duodenal sweep. E, Placement of 2 endoclips proximal to the bleeding lesion for further endoscopic versus interventional radiology s. F, EUS view showing no evidence of pancreatic divisum with an anatomically normal pancreatic duct. G, Major and minor papilla visualized on ated endoscopy. The blood clot thought to be overlying the minor papilla was in fact visualized at a separate location. H, Deployment of over-thee “bear claw” clip to close bleeding fistula.