LAUSR

A 21-year-old woman who previously underwent choledochojejunostomy during childhood was admitted with a 1-week history of worsening upper abdominal pain. She was diagnosed with acute pancreatitis, and magnetic resonance cholangiopancreatography (MRCP) revealed a pancreatic divisum with multiple stones in both dilated ventral and dorsal pancreatic ducts (▶Fig. 1). An endoscopic retrograde cholangiopancreatography (ERCP) was performed. Initial endoscopic assessment found a stenosed proximal duodenum (▶Fig. 2) and it was not passed until a smaller JF-240 duodenoscope (Olympus, Tokyo, Japan) with an 11-mm outer diameter was changed. The major papilla was cannulated and a cholangiogram showed a few anomalies. First, there was a dilated fusion with multiple calculi between the ventral pancreatic and common bile duct. The distal main pancreatic duct was not seen (▶Fig. 3). Secondly, it also revealed a stenosed side-to-side choledE-Videos