Endoscopic retrograde cholangiopancreatography (ERCP) can be mentioned as the most complex endoscopic procedure and is widely used for diagnosis and treatment of biliary and pancreatic diseases. Pancreatitis is the most common complication following ERCP, which may be life threatening. This article presents an old woman diagnosed as having post-ERCP pancreatitis without increasing in serum amylase level

A 69-year-old woman with a history of cholecystectomy a few years earlier, was presented with abdominal pain in epigastric region. Abdominal sonography revealed a dilated common bile duct [(CBD), 11 mm in diameter)] so MRCP (Magnetic Resonance Cholangiopancreatography) was performed for diagnosis. There were several stones in CBD, so the patient underwent therapeutic ERCP. Six hours after the procedure, she complained of severe abdominal pain in the right upper quadrant (RUQ) and tenderness. Serum amylase was 51 mg/dL. An abdominal computed tomography revealed pancreatitis.

Pancreatitis is the most common complication after ERCP, which presents with abdominal pain in the RUQ and increase in serum amylase level more than 3 fold of normal upper limit. In this case, pancreatitis occurred without laboratory findings consistent with the diagnosis, which is not a common occurrence.