Differential Diagnosis for Abdominal Pain 1 Hour After ERCP

Single Most Likely Diagnosis

• Pancreatitis: This is the most common serious complication of ERCP, occurring in approximately 1-7% of patients. The onset of abdominal pain, especially in the upper abdomen, shortly after the procedure is highly suggestive of pancreatitis. The risk factors, such as young age, female sex, sphincter of Oddi dysfunction, and a history of recurrent pancreatitis, can increase the likelihood.

Other Likely Diagnoses

• Cholangitis: Infection of the bile duct, which can occur after ERCP, especially if there was instrumentation of the biliary tree. Symptoms can include abdominal pain, fever, and jaundice.
• Perforation: Although less common than pancreatitis, perforation of the gastrointestinal tract during ERCP can lead to severe abdominal pain shortly after the procedure. The pain can be constant and severe.
• Hemorrhage: Bleeding can occur as a complication of ERCP, either from the site of sphincterotomy or from other areas of the gastrointestinal tract that were instrumented during the procedure.

Do Not Miss Diagnoses

• Perforation of the Duodenum: While less likely than pancreatitis, a perforation is a surgical emergency that requires prompt recognition and treatment to prevent severe morbidity and mortality.
• Severe Hemorrhage: Significant bleeding can lead to hypovolemic shock and death if not promptly addressed. Early recognition and intervention are critical.
• Sphincter of Oddi Dysfunction: Although not immediately life-threatening, missing this diagnosis can lead to ongoing pain and potentially more severe complications if not managed properly.

Rare Diagnoses

• Cardiovascular Events: Myocardial infarction or other cardiac issues can be precipitated by the stress of the procedure or underlying conditions. While rare, these are critical to identify promptly.
• Pulmonary Embolism: A rare but potentially fatal complication that could present with abdominal pain if the embolism affects the lung bases and refers pain to the abdomen.
• Intra-abdominal Abscess: A potential complication of ERCP, especially if there was a perforation or introduction of bacteria into the peritoneal cavity. This might present later than 1 hour post-procedure but is included for completeness.