Acute gallstone pancreatitis: a constant challenge for the surgeon

Acute pancreatitis is an inflammation of the pancreas caused by autodigestion of the gland by its enzymes. It includes a broad spectrum of pancreatic disease, which varies from parenchymal edema to necrosis. The objective of the current study was to describe the symptoms of the patients with gallstone-associated pancreatitis and to reinforce the opinion that operation, within the first 72 hours after the onset of the disease, has many advantages and has to be considered as a treatment option when ERCP is not available.

The present retrospective study concerns all patients that were hospitalized in Mamatsio Hospital of Kozani during the period between Jan 1, 1997 and Dec 1, 2002 under the diagnosis of gallstone-associated acute pancreatitis. From the records 108 cases were identified (43 males and 65 females). The mean age was 62.93 (SD 15.85 years), ranging from 17 to 91 years.

24 patients (22.22%) fulfilled more than 3 of Ranson's criteria. 20 patients (18.52%) presented necrotizing pancreatitis. All patients underwent open cholecystectomy and common bile duct exploration. Necrosectomy concomitantly with cholecystectomy was performed in 7 patients (6.48%). The mean hospitalization was 10.53 days (S.D. 6.38 days), ranging from 2 to 36 days. The associated mortality reached 5.55% (6 patients) and no patient died in the operating theater. During the 12-month follow-up period, 2 patients (1.85%) developed pancreatic pseudocysts.