Differential Diagnosis for Upper Abdominal Pain after Failed ERCP for Impacted CBD Stone

• Single most likely diagnosis:

  • Post ERCP pancreatitis: This is a common complication of ERCP, especially if the procedure was difficult or prolonged, which might be the case if the stone could not be removed. Pancreatitis would explain the ongoing upper abdominal pain and mild tenderness.

• Other Likely diagnoses:

  • Cholangitis due to CBD stone: Although the ERCP was attempted, the failure to remove the stone could lead to persistent obstruction, increasing the risk of cholangitis, an infection of the bile duct. Symptoms can include abdominal pain, fever, and jaundice.
  • Acute on chronic cholecystitis: If the patient has a history of gallstones, the current situation could exacerbate or trigger an episode of cholecystitis, especially if there's ongoing obstruction of the bile duct.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):

  • Duodenal perforation: A serious complication of ERCP, duodenal perforation requires immediate surgical intervention. While less common, it's critical to consider due to its high mortality rate if not promptly treated.
  • Bleeding: Significant bleeding can occur as a complication of ERCP, either from the sphincterotomy site or from the attempted stone removal. It's crucial to identify and manage promptly to prevent severe outcomes.

• Rare diagnoses:

  • Other rare complications of ERCP, such as retroperitoneal perforation or hemobilia, could also present with abdominal pain but are less likely than the aforementioned conditions. These would be considered if other diagnoses are ruled out and the patient's condition does not improve or worsens over time.