Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٣٠
The pancreas can appear relatively normal in cases of mild
inflammation .In more severe cases, the entire gland is enlarged and
enhances heterogeneously (Balthazar, 1989). Pancreatic necrosis
accounts for over 70% of deaths from acute pancreatitis because digestive
enzymes leak with disruption of the pancreatic duct. The necrotic tissue
can evolve into an intrapancreatic collection with a pseudocapsule. Foci
of high attenuation are due to hemorrhage (Paulson et al., 1999).
Patients with acute pancreatitis can develop pseudocysts after the
initial attack has subsided.These are encapsulated collections that can
have a barely perceptible wall or a thick, enhancing wall and
communicate with the pancreatic duct .Other possible complications of
acute pancreatitis are pseudoaneurysms, pleural effusions, and ascites
(Balthazar, 1989). Involvement of the extraperitoneal portions of the
colon can lead to perforation and stricture formation (Stanley et al.,
1998).
Pharmacologic prophylaxis of pancreatitis:
Several methods of pharmacologic prophylaxis have been proposed.
Somatostatin and octreotide reduce pancreatic secretion and therefore
may limit pancreatic duct hypertension (Binmoeller et al., 1992). Other
agents have been used in an effort to reduce spasm of the sphincter of
Oddi (Sand et al., 1993), inhibit proteolytic activity (gabexate),
(Cavallini et al., 1996) block the production of free radicals (allopurinol)
(Budzynska et al., 2001) or manipulate the cytokine cascade (IL-10)
(Dumot et al., 2001).
2- Hemorrhage:
Hemorrhage is primarily a complication related to sphincterotomy
rather than diagnostic ERCP. Clinically significant hemorrhage may be