# Postoperative Pancreatitis Following Intraoperative Cholangiography: A Case Report

## TL;DR

A patient developed postoperative pancreatitis after intraoperative cholangiography during gallbladder surgery, highlighting the need for close monitoring.

## Contribution

This case report adds to the understanding of a rare complication of intraoperative cholangiography—postoperative pancreatitis.

## Key findings

- Contrast reflux into the pancreatic duct during IOC was observed in the patient.
- The patient developed acute interstitial pancreatitis confirmed by CT cholangiogram.
- Symptoms resolved with intravenous fluids and supportive care within four days.

## Abstract

Intraoperative cholangiography (IOC) is frequently performed during laparoscopic cholecystectomy to delineate biliary anatomy and detect choledocholithiasis. While generally safe, postoperative pancreatitis following IOC is an uncommon and under-recognized complication. We report the case of a 41-year-old male patient who presented with postprandial pain on a background of symptomatic gallstones. Preoperative blood tests, including liver function tests, were unremarkable, and ultrasound demonstrated gallstones with a non-dilated common bile duct (CBD). He underwent an uncomplicated laparoscopic cholecystectomy with IOC, which revealed contrast reflux into the pancreatic duct. The following day, he developed severe epigastric pain radiating to the back, nausea, vomiting, tachycardia, and low-grade fever. Blood tests showed elevated lipase (2000 U/L) and deranged liver function. Computed tomography (CT) cholangiogram confirmed acute interstitial pancreatitis without evidence of bile leak, choledocholithiasis, or pancreaticobiliary maljunction. He was managed with intravenous fluids, patient-controlled analgesia, and supportive care, and discharged home on day 4. This case highlights the importance of recognising contrast reflux as a possible precipitant of pancreatitis and the need for close postoperative monitoring.