Figure 10a. Hemorrhage and perforation after ERCP in a 67-year-old woman. Cannulation of the common bile duct was unsuccessful, and the patient experienced pain after the procedure. CT was performed with intravenous contrast material on the day of ERCP. (a) CT scan shows free retroperitoneal air (solid arrow) between the duodenum and pancreatic head and just posterior to the gastroduodenal artery (open arrow). The small amount of fluid and the stranding of fat in the right anterior pararenal space (*) are secondary to inflammation. The common bile duct is dilated. (b) CT scan obtained inferior to a shows a high-attenuation hematoma (arrow) between the duodenum and pancreas. (c) CT scan obtained inferior to b shows a high-attenuation mass (arrow) that appears to be abutting the lumen of the duodenum, a finding compatible with an intramural hematoma. The patient was treated conservatively and recovered within 3 days.