Post ERCP pancreatitis

Case contributed by Bita Abbasi
Diagnosis certain


Post ERCP abdominal pain

Patient Data

Gender: Female

Pancraetic head is minimally hypoattenuating, but not enlarged. There is fat stranding in the peripancreatic fat.

Peripancreatic and right perirenal fluid collections. There is also free fluid in the right paracolic, subhepatic (Morison pouch), right subphrenic, and pelvic spaces.

Gallbladder and extra and intrahepatic biliary ducts are filled with contrast which is due to its use during ERCP. This allowed me to make a 3D reconstruction from the biliary tracts.

Case Discussion

Acute pancreatitis occurs in approximately 5% of diagnostic procedures and 10% of therapeutic procedures. A commonly used definition of post-ERCP pancreatitis is abdominal pain for >24 hours after the procedure and levels of serum pancreatic enzymes three times above normal. This definition excludes the 30–75% of patients who are asymptomatic and have an elevated amylase level alone. Asymptomatic hyperamylasemia peaks 90 minutes to 4 hours after ERCP and resolves within 48 hours.

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