The aorta and inferior mesenteric artery (IMA) were distorted to the right by severe scoliosis, which caused the IMA to run close to the tumor and the papilla of Vater (Fig. 2 Contrast-enhanced computed tomographic images (coronal view). a The aorta is distorted to the right due to severe scoliosis. b The inferior mesenteric artery (arrow) runs close to the tumor (arrowheads) and papilla of Vater (circle). In the present case, for example, if we had performed papillary dilation using an ultrathin-tipped balloon catheter for biliary stricture [3] to overcome the difficult catheter passage across the papilla, endoscopic hemostasis would have been impossible. [Extracted from the article]