Case records of the Massachusetts General Hospital: Case 27-2003: A 36-year-old man with recurrent epigastric pain and elevated amylase levels

Computed tomographic (CT) scanning of the abdomen and pelvis, performed after the oral and intravenous administration of contrast material, showed that the head and body of the pancreas were enlarged; there was no evidence of dilatation of the pancreatic duct or common bile duct (Figure 1 ). Seven weeks before admission, a repeated endoscopic retrograde cholangiopancreatographic examination showed that the stricture that had been seen in the distal third of the common bile duct on the previous examination appeared to have resolved; there was diffuse irregularity of the duct in the pancreatic head, and the main pancreatic duct was completely obstructed at the level of the pancreatic neck (Figure 2B ).