Duodenal papillitis

Discussion:

This case with a remote history of cholecystectomy represents features of acute obstructive jaundice with no intraluminal obstructing etiology and bulging duodenal papilla with mural stratification and mild enhancement that is most likely representing papillitis. Endoscopy showed enlarged duodenal papilla with inflammation and performed endoscopic sphincterotomy.

The normal major duodenal papilla can barely be distinguished from the surrounding duodenal mucosal folds. It appears as a protuberance less than 10 mm in diameter with enhancement comparable to that of the adjacent duodenal mucosa. 

Duodenal papillitis is an inflammation that can present due to infection, parasites, recently passed stone, choledocholithiasis, impacted ampullary stone, periampullary diverticulum and can occur in conjunction with acute cholangitis, acute pancreatitis, or acute exacerbation of chronic pancreatitis 1.

The inflamed papilla usually displays symmetric thickening (> 5~10 mm) with homogeneously increased enhancement and mural stratification in the form of target-like enhancement. This finding helps distinguish benign papillitis from hypovascular malignant conditions on CT 1.

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