Chapter 54: Pancreas- Gallstone Pancreatitis

Question 1

What is it?

Answer 1

Acute pancreatitis from a gallstone in or passing through the ampulla of Vater (the exact mechanism is unknown)

Question 2

How is the diagnosis made?

Answer 2

Acute pancreatitis and cholelithiasis and/or choledocholithiasis and no other cause of pancreatitis (e.g., no history of alcohol abuse)

Question 3

What radiologic tests should be performed?

Answer 3

• U/S to look for gallstones
• CT scan to look at the pancreas, if symptoms are severe

Question 4

What is the treatment?

Answer 4

Conservative measures and early interval cholecystectomy (laparoscopic cholecystectomy or open cholecystectomy) and intraoperative cholangiogram (IOC) in 3 to 5 days (after pancreatic inflammation resolves)

Question 5

Why should early interval cholecystectomy be performed on
patients with gallstone pancreatitis?

Answer 5

Pancreatitis will recur in ≈33% of patients within 8 weeks (so always perform early interval cholecystectomy and IOC in 3 to 5 days when pancreatitis resolves)

Question 6

What is the role of ERCP?

Answer 6

• Cholangitis
• Refractory choledocholithiasis