Management of Acute Biliary Pancreatitis in Cholecystectomized Patients

Abstract

Objective:We aimed to evaluate the patients who were hospitalized, followed up and treated in our clinic with the diagnosis of acute biliary pancreatitis (ABP) after cholecystectomy.Methods:The electronic records of 18 patients with a history of cholecystectomy were reviewed retrospectively. The demographic findings of the patients, time passed after cholecystectomy, methods used in diagnosis, amylase levels, treatment choices, clinical follow-ups, mortality and morbidity rates, and length of hospital stay were evaluated. The Ranson criteria and Apache II score were used to determine the severity of pancreatitis.Results:Thirteen (72.2%) were female and 5 (27.8%) were male. The mean age was 57.83±12.59 (34-77). The mean time elapsed after cholecystectomy was 72.11±38.12 (5-130) months. The mean diameter of the common bile duct (CBD) was measured as 12.39±2.30 (8-15) mm. The average level of amylase was 986.50±323.29 (350-1530) U/L. Fifteen (83.33%) patients had mild, and 3 (16.67%) patients had moderately severe acute biliary pancreatitis. Endoscopic sphincterotomy (ES) was performed on 16 patients during endoscopic retrograde cholangiopancreatography (ERCP). Two patients were operated due to failure of ERCP. Choledochotomy, transduodenal sphincteroplasty and The T-tube drainage were performed on 1 patient. The other patient underwent choledochotomy and choledochoduodenostomy. The average length of stay in hospital was 7.89±4.91 (5-25) days.Conclusion:It should be kept in mind that ABP may develop months or even years after cholecystectomy. The standard treatment for acute pancreatitis caused by CBD stones in patients with cholecystectomy are ERCP and ES. In patients with failed ERCP and ES, the CBD exploration should be performed surgically.

Keywords

• acute pancreatitis
• cholecystectomized patients
• endoscopic retrograde cholangiopancreatography