Necrotizing Pancreatitis Associated With an Ingested Screw Adjacent to the Ampulla of Vater

ABSTRACT A 78-year-old man presented with severe epigastric pain and was diagnosed with acute pancreatitis that progressed to necrotizing pancreatitis despite supportive management. No common etiologies were identified. During endoscopic nasojejunal feeding tube placement, a metallic screw was incidentally discovered in the second portion of the duodenum adjacent to the major papilla and successfully removed. The foreign body had not been detected on previous computed tomography, ultrasound, or abdominal radiography. The patient recovered completely without recurrence. This case highlights a rare periampullary foreign body in otherwise unexplained pancreatitis and raises the possibility of a mechanical contribution to disease pathogenesis.