The origin of this fistula was a prepapillary stone perforation Juxtapapillary diverticula adjacent to papilla. The orifice of the duct is located on the edge of the di- verticula. The papilla might also be hidden in the depth of the diverti- cula. After a severe colic attack ERCP shows a stone stuck in the papilla. Compression of the peripapillary tissue results in a beginning necrosis.
Impossible intubation necessitates a precut alongside the stone.
After EPT the stone is spontaneously released to the duodenum. The patient presents with recurrent attacks of epigastric pain coinciding with chronic diarrhea, which led to a weight loss of 7 kg. There is a history of cholecystectomy 30 years ago. The biliary tree is visualized by application of contrast medium via the ERCP catheter. The following ERCP gains normal access to the pancreatic duct via the papilla.