In the upper portion of the picture the lumen of the bile duct is to be seen. The wide biliary orifice persists. Such a wide papillotomy was only justified by the massive stone accumulation in the bile duct. Complications EPT was performed for symptomatic obstructive jaundice with a cholecyst- ectomy in history. Severe colic developed three days after EPT and stone extraction.
Endoscopic evaluation reveals a massive hemorrhage in the middle part of the duodenum.
The papilla is covered by a big sentinal clot. After evacuation of the blood the bleeding site can be localized to the papilla s roof. An active oozing hemorrhage can be seen. A close up shows a huge visible vessel just above the needle. The cause of the colic attacks is identified by contrast recesses on radiographs, possibly representing clots in the ductular lumen.