Idiopathic Acute Pancreatitis and Sphincter of Oddi Dysfunction: Diagnostic and Therapeutic Role of ERCP and Sphincter of Oddi Manometry

Abstract

A 44-year-old female presents to the office 1 month following an episode of acute pancreatitis (AP). She denies a history of alcohol use and smoking, has no family history of pancreatitis, and takes no medications. At the time of her presentation, serum liver chemistries, calcium, and triglyceride levels were normal; serum lipase was more than three times the upper limit of normal. At the time of admission, a transabdominal ultrasound (US) showed changes of prior cholecystectomy; this had been performed for intermittent abdominal pain and suspected chronic cholecystitis 5 years ago. The common bile duct was poorly visualized but felt to be normal in diameter. During her admission, a contrast-enhanced abdominal computed tomography (CT) revealed peripancreatic stranding consistent with interstitial AP. There was no evidence of chronic pancreatitis or other structural abnormalities.She has fully recovered from this recent episode of AP, but now reports intermittent episodes of transient, mild epigastric pain, each lasting 15-60 min. She is asymptomatic in the office, but concerned for her risk of permanent damage to her pancreas, and fears recurrence of the severe abdominal pain that prompted admission with AP. She is diagnosed with idiopathic AP. What is your diagnostic and therapeutic approach?