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Global Journal of Surgery. Volume 1, Issue 1 (2010) pp. 17-40
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Review Article
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Gall stone pancreatitis
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Sanjay Marwah* and Jaiprakash Gurawalia
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Department of Surgery, Pt BD Sharma Post-graduate Institute of Medical Sciences, Rohtak, Haryana , India
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Abstract |
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Acute pancreatitis is a well known complication of gall stone disease and in severe cases it has significant morbidity and mortality. It is the most common preventable cause of pancreatitis. In developed countries, at least one in every ten adults carries gall stones and as per published reports, the incidence of gall stone pancreatitis is increasing. Although gall stones are known to induce pancreatitis, but exact triggering mechanism still remains uncertain. It is assumed that pancreatitis may be induced by obstruction of ampulla of Vater by migrating stone through the common bile duct. Stone related factors (small, multiple stones and biliary sludge) and pancreato-biliary anatomy (wide cystic duct with low insertion) may be contributing factors. However it is well established that acute pancreatitis results from premature activation of proteolytic enzymes within pancreatic acinar cells. In most cases of gall stone pancreatitis, the diagnosis can be made with acceptable accuracy by clinical, laboratory and radiological findings. The presence of abdominal pain, nausea, vomiting, elevated amylase levels and sonologically confirmed biliary calculi are considered adequate for diagnosis. MRCP and EUS are superior to USG in picking up CBD stones. Various scoring systems and CECT abdomen are useful in assessment of extent and severity of the disease that helps in deciding management and determining prognosis. The cases with severe necrotizing pancreatitis require management in ICU to control organ failure and to reduce mortality. In gall stone pancreatitis, cholecystectomy should be done as soon as the patient has recovered from acute attack. Early cholecystectomy in such cases results in a decreased risk of recurrent pancreatitis and its complications. It is well accepted that in patients with mild attack of pancreatitis, cholecystectomy during same hospitalisation is safe. However there is controversy over proper timing of operation in patients with severe necrotizing pancreatitis because they are unsuitable for surgical intervention during initial admission. These patients are preferably discharged and readmitted within six months for interval cholecystectomy. However in cases of severe necrotizing pancreatitis presenting with jaundice and cholangitis, early ERCP and endoscopic sphincterotomy helps in preventing further complications.
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Keywords |
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Gall stones; Pancreatitis
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