English

Abstract

BACKGROUND Multiple practice guidelines from different American and European societies recommend index hospitalization cholecystectomy following an episode of gallstone pancreatitis. We wanted to analyse the outcome of patients presenting with acute pancreatitis in the presence of gall stones, analyse the sensitivity and specificity of liver function tests in early prediction of acute biliary pancreatitis and establish the advantages of early intervention in acute biliary pancreatitis. METHODS This is a prospective study conducted at a tertiary care hospital for a period of 12 months among 100 cases of acute pancreatitis who presented with abdominal pain with serum amylase level 3 times the normal limits in the absence of hypercalcemia or hyperlipidaemia. Presence of gallstones was confirmed on ultrasonography. Patients were subjected to preoperative ERCP and endoscopic sphincterotomy. Intraoperative and postoperative morbidity and mortality, and postoperative hospital stay were reported. RESULTS Gall stones were the cause of pancreatitis in 16 out of 100 cases (16 %). Male to female ratio was 1 : 3. Mean occurrence of age was 51.1 years. Preoperative ERCP was done 10 cases (63 %). Laparoscopic Cholecystectomy was performed in all the 16 cases (100 %) of which 12 cases (75 %) underwent Lap cholecystectomy in the same admission and 4 cases were subjected to interval cholecystectomy. 1 case was converted to open procedure. Post-operative complications include nausea and vomiting in 2 cases, chest infection in 2 and bile leak in 1. CONCLUSIONS Management of acute pancreatitis in the presence of gallstones requires prompt diagnosis and timely intervention. Laparoscopic cholecystectomy can be safely performed for mild to moderate acute biliary pancreatitis after clinical and biochemical resolution of the attack during the same admission with acceptable morbidity and mortality rates. This strategy will lead to reducing the recurring acute biliary pancreatitis, number of admissions and hospital stay. KEYWORDS Acute Pancreatitis, Gallstones, LFT, Lipase, Amylase, ERCP, Laparoscopic Cholecystectomy