Žučni kamenci i pravo vreme operacije - čekati ili intervenisati?

Abstract

Introduction: Gallstones are the most common cause of biliary pancreatitis. After the alleviation of the acute phase of pancreatitis, the surgery follows in the majority of cases (cholecystectomy). Objective: To present when is the right time for surgical intervention in gallstone cases after pancreatitis as a complication. Case report: An 85-year-old patient presents with abdominal pain. He is afebrile, eupnoeic, pale, BP 140/80 mmHg, with diffuse abdominal tenderness to palpitation. Native abdomen X-ray shows hydroaeric levels. The patient was referred to a surgeon and operated on urgently. Cholecystectomy was not performed. Due to cardiovascular disease and problems with blood vessels, the patent had had two cardiosurgical interventions in the past. Three months after cardiosurgical intervention the patient presents with jaundice at his CiP office. Physical examination confirms the yellow color of skin and mucosae. The patient is afebrile, without abdominal tenderness. Serological blood tests were negative for hepatitis B, C, and HIV. Abdominal ultrasonography showed a stone in the gallbladder and it was consistent with greater risk of recidivant biliary pancreatitis. The patient was operated and the total cholecystectomy was performed. Conclusion: Patients with gallstones are at higher risk for acute pancreatitis. In patients with gallstones and consecutive biliary pancreatitis as a complication, cholecystectomy should be performed during the first hospitalization.