Postoperative Pancreatitis Following Intraoperative Cholangiography: A Case Report.

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.