He has been a heavy smoker and consumes greater than 80g ethanol per day. He has had a previous diagnosis of alcohol induced chronic pancreatitis, due to a history of chronic epigastric pain and CT Scan evidence of calcification in the pancreas.
Clinical examination reveals no jaundice or lymphadenopathy.
He has some epigastric fullness and tenderness. CT Scan suggests an enlarged head of pancreas but no discrete mass or pseudocyst. An ERCP is performed. Endoscopy reveals a distorted and edematous duodenal mucosa with ulceration of the minor papilla. Image 1 Cholangiogram showing a distal biliary stricture.