Duodenal obstruction following acute pancreatitis caused by a large duodenal diverticular bezoar

Figure 1 Abdominal computed tomography findings. A: The pancreas head showed swelling with irregular contour of the pancreatic margin and mild peripancreatic infiltration; B: There is a 5 cm size subtle rim enhancing mass with air bubbles, indicating acute diverticulitis in the second duodenal portion or air forming abscess of the pancreatic head; C: After nine days, a few extraluminal air bubbles (arrow) suspicious for microperforation were found.

Figure 2 Endoscopic findings. A: There is a huge luminal obstructing bezoar near the duodenal diverticulum; B: The bezoar was too large to be captured and removed by an endoscopic basket or net.

Figure 3 Surgical findings. A: Obstructed duodenum with impacted huge bezoar (arrow); B: Surgical specimen of the divided bezoar, 5 cm long, 2.5 cm in diameter.

Figure 4 Upper gastrointestinal series show two periampullary diverticula (arrows) in the second duodenal portion.