Endoscopic ultrasound for the diagnosis of an uncommon cause of obstructive jaundice masquerading as malignancy

10.4103/2303-9027.190926 A 42‐year‐old man with a history of alcohol consumption and smoking habit presented with abdominal pain, jaundice, and weight loss of 3‐month duration. Laboratory results were significant for total bilirubin level of 5 mg/dL, direct bilirubin level of 4 mg/dL, aspartate aminotransferase (AST) level of 81 IU/L, alanine transaminase (ALT) 66 IU/L, and alkaline phosphatase level of 1,200 IU/L. An abdominal computed tomography (CT) scan showed signs of chronic pancreatitis and a suspected pancreatic head mass causing obstructive dilatation of the common bile duct (CBD) [Figure 1]. An endoscopic retrograde cholangiopancreatography (ERCP) revealed a 2-cm stricture in the distal part of the CBD. Brush cytology was performed and a plastic biliary stent was successfully placed to relieve the obstruction. An endoscopic ultrasound (EUS) with radial echoendoscope (GF-UE160-AL5, Olympus, Hamburg, Germany) showed a marked thickening of the second portion of the duodenum due to an enlargement of submucosal layer that had a pancreas‐like echostructure, without hypoechogenic cavities. The biliary stent was surrounded by this thickened duodenal wall and no mass was found in the pancreatic head [Figure 2]. Results of brush cytology were negative for malignancy. These findings suggested a solid form of paraduodenal pancreatitis (PP) in a patient with chronic calcifying pancreatitis. A rapid clinical improvement was seen soon after alcohol withdrawal and without any other treatment. At a 3‐month follow‐up visit, the patient was persistently asymptomatic, with the plastic stent still in site.