[Our experience with the diagnosis and treatment of biliary pancreatitis]

The diagnostic and therapeutic problems faced during treatment of thirty-nine patients presenting biliopancreatitis (BP) are discussed. BP diagnosis is made on the ground of clinical picture, laboratory indicators, abdominal ultrasonography, intraoperative cholangio-pancreatography and cholangioscopy. Patients with cholelithiasis (ChL) of long-standing in the previous history are predominant, with the age group exceeding 50 years of age being most numerous, and the female gender prevailing. All patients undergo conservative pre- and postoperative treatment. Operative treatment in BP is performed as an emergency intervention. Cholecystectomy is done in all cases, and in 56.3 per cent of them it proves sufficient to promote a favourable outcome of the pathologic condition. External or internal drainage of the choledochus is necessitated in the presence of definite indications (obstruction of extrahepatic biliary ducts and pancreas documented by operative cholangiography, choledochoscopy and probing). Dilatation of the papillary sphincter is carried out in five patients (12.8 per cent) because of partial papillary stenosis. The destructive forms of pancreatitis are treated by gland draining in conjunction with necrectomy and drainage of the extrahepatic biliary ducts. A correlation is established between the incidence of destructive forms of pancreatitis and therapeutic results, on the one hand, and timing of the operative intervention, on the other. Operative management of BP is a method of choice insofar as it contributes to the complex and thorough treatment of the condition. Preoperative BP diagnosis is still a problem not well enough clarified which leads to delayed operation with an adverse impact on the prognosis of the disease.