Background: Acute pancreatitis is an important complication of endoscopic retrograde cholangiography (ERC), occurring between 1-10% of patients. Several randomized controlled trials and meta-analyses have demonstrated the effectiveness of nonsteroidal anti-inflammatories (NSAIDs) such as diclofenac and indomethacin as a post-ERC pancreatitis (PEP) prophylaxis. The aim is to determine if the rectal diclofenac use reduces the PEP rate. Methods: Retrospective cohort study. Subjects were included who underwent ERC for different indications in a tertiary center between January 2015 and June 2016. Two groups were analyzed: group A (without diclofenac use) and group B (with use of diclofenac as PEP prophylaxis). Biodemographic, technical and mortality variables were measured.Results: The total cohort was 116 patients, 67 in group A and 49 in group B. The average age was 61.9±17.8 and 58.3±15.8 years, respectively (P=0.2606). Gender distribution showed a women predominance in both groups (P=0.933). Of the technical variables measured, the precut showed a statistically significant relationship to PEP (P=0.013). Of the total cohort, 8.6% developed acute pancreatitis after an ERC: four in group A and six in group B (P=0.196). In those who developed PEP (n=10), six patients developed severe acute pancreatitis (SAP). The average hospitalization for PEP was 32.2±34 days (P=0.881). No patients died, not were there any adverse reactions to the drug. Conclusions:Rectal diclofenac administered at the beginning of the ERC did not reduce the PEP rate in this patients cohort.

Complications from the installation of a Kehr tube are frequent, up to 15% in some series.Hepatic abscesses secondary to a foreign intraciliary body are very rare. Actinomycosis is a rare chronic infection, has a liver involvement of 5% secondary to another intra-abdominal infection. We present a case of female patient aged 79 years. History of choledochostomy in 2007 due to choledocholithiasis and endoscopic biliary drainage due to residual choledocholithiasis. She consulted for pain in the epigastrium and right hypochondrium, associated with an increase in inflammation markers. Initial ultrasound identified a lesion in the left hepatic lobe compatible with a hepatic abscess. Nuclear magnetic resonance (NMR) revealed dilation of the intrahepatic bile duct, greater to the left, with thickening of the bile duct at the confluence level that extends to the middle third, with hepatolithiasis and choledocholithiasis and multiple hepatic abscesses. A left lateral segmentectomy was performed along with exploration of the bile duct, identifying a foreign body compatible with an old fragment of T tube. The deferred biopsy reported intrahepatic lithiasis and chronic hepatitis compatible with secondary biliary cirrhosis, acute and chronic hepatitis with purulent leukocytic exudate and actinomycete elements. In our case the T tube fragment could have acted as a foreign body and facilitated the infection by actinomyces.