Biliary peritonitis can cause subserosal bile staining that mimics pyloric or duodenal necrosis. When endoscopy or ICG fluorescence is unavailable, pseudonecrosis remains an operative diagnosis of exclusion, supported by preserved serosal integrity, absence of visible perforation, careful inspection, and uneventful 1-month follow-up.
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Mouawad et al. (2026) studied this question.
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