Acute Biliary Pancreatitis in Cholecystectomised Patients

Abstract

OBJECTIVE:The present study is an evaluation of cases of acute biliary pancreatitis that developed subsequent to cholecystectomy.METHODS:Total of 44 patients were assessed in this retrospective study. Demographic characteristics, severity of illness, time elapsed between cholecystectomy and development of pancreatitis, whether endoscopic sphincterotomy (ES) was performed, surgical procedure used, duration of hospitalization, and mortality data were recorded.RESULTS:Mean age of all patients was 60.14±16.4 years (range: 20–85 years), and female:male ratio was 28:16. Mean length of time elapsed between cholecystectomy and development of acute pancreatitis was 80.6 months (range: 5–230 months). Gallstones and biliary sand were found in the choledochi of 36 patients upon endoscopic retrograde cholangiopancreatography (ERCP), but not observed in the remaining 8 patients. ES was performed and material was extracted in 32 of the 36 patients, but stone extraction was unsuccessful in 4 cases; 3 patients underwent open surgery with choledochus exploration and 1 patient died. Excluding this patient, mean duration of hospitalization was 7.5±2.5 days.CONCLUSION:Stones in bile ducts may remain asymptomatic for long periods after cholecystectomy. However, some stones trigger acute pancreatitis months or years after cholecystectomy, causing risk of mortality. ERCP and ES are the standard treatments. If these are unsuccessful, the choledochus may be explored via open or laparoscopic surgery.

Abdominal Pain, Vomiting, and Weight Loss in a 17-Year-Old Girl

“…Cases of gallstone pancreatitis after cholecystectomy have been described in adults, although rare. 16,17 One case series found a varying time interval between cholecystectomy and pancreatitis of 5 to 230 months with a median of 80.6 months. 16 However, our case is the first described pediatric instance in our literature review.…”

“…16,17 One case series found a varying time interval between cholecystectomy and pancreatitis of 5 to 230 months with a median of 80.6 months. 16 However, our case is the first described pediatric instance in our literature review. With the recent increase in the incidence of pediatric pancreatitis, 7 it is advisable for clinicians to maintain an index of suspicion for AP in patients who present with abdominal pain or vomiting, the 2 most common presenting symptoms.…”