Retained common bile duct stone in mild to moderate gallstone pancreatitis (original) (raw)
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Surgery, 2015
Background. In 2009, a study from our institution used retrospective data and multivariate analysis to identify 5 quantitative variables and their cutoffs that have a positive predictive value (PPV) for common bile duct (CBD) stones in gallstone pancreatitis. They also proposed a management protocol based on the scoring system. This prospective study sought to validate that scoring system. Methods. From October 2009 to August 2013, patients with gallstone pancreatitis were enrolled in the study.
Journal of Gastrointestinal Surgery, 2008
Introduction Management of uncomplicated common bile duct stone (CBDS) and gallstone pancreatitis (GP) presumably varies based on whether a patient is admitted to medicine or surgery. This study evaluates the impact of admitting team on outcome and cost. Methods Three hundred seventy patients admitted to the Massachusetts General Hospital for CBDS or GP were retrospectively analyzed for demographics, insurance status, procedures, complications, length of stay, readmission, and cost. A multivariable analysis was conducted for outcome and cost measures.
2021
Acute biliary pancreatitis is common surgical emergency with wide array of symptoms. Revised Atlanta Classification has devised criteria for the diagnosis of the pancreatitis and has defined the severity of pancreatitis and various complications arising from the pancreatitis. Early diagnosis is imperative to start the management of the patients which is usually supportive. In our study, we assessed clinical profile, severity, complications and managed patients based on standard guidelines. Majority of cases, in our study, followed a mild course and a few developed local or systemic complications. Definitive treatment involved early cholecystectomy for mild cases wherever possible and interval cholecystectomy for the severe cases. Management of complications has improved with step-up approach. Recurrence of acute pancreatitis was witnessed when patient did not undergo cholecystectomy or was waiting for the definitive procedure.
Gut, 1990
This study was carried out to assess pancreatic duct abnormalities in gall stone disease. Endoscopic retrograde cholangiopancreatograms of 50 patients with gall stone disease were analysed and the results compared with those obtained in 33 patients investigated for cholestatic jaundice who were found to have a normal biliary tree (control group). Abnormal pancreatograms were obtained in 24 (48%) patients with gall stone disease and in only two (6%) in the control group; the differences were statistically significant (x2=14X3; p<0 001). The patients in the control group showed mild abnormalities as did those in the gail stone group. The frequency of various abnormalities were: mild 16 (32%), moderate five (10%), and severe three (6%). Pancreatic duct abnormalities were more severe and occurred more frequently in patients with gail stones who had stones in the biliary tree than in patients with a normal biliary tree (postcholecystectomy patients, 55% v 25%) but the difference between the two groups just failed to be significant (x2=3 34). In conclusion, nearly half of all patients with gall stone disease have pancreatic duct abnormalities and in 16% these were severe enough to be labelled as chronic pancreatitis.
International Journal of Medical Reviews and Case Reports, 2020
Gallstone pancreatitis is a serious complication of gallstone disease. Early diagnosis is pivotal. History, laboratory tests and CECT are diagnostic. The severity assessment is necessary for planning optimum aggressive management. ERCP is indicated in patients of biliary pancreatitis with obstructed CBD stones complicated by cholangitis. Cholecystectomy is indicated after inflammatory markers have normalised suggesting the resolution of pancreatitis. Cholecystectomy should be done preferably during the index admission.
FREQUENCY OF PANCREATITIS IN PATIENTS DUE TO GALL STONES
JPTCP, 2023
Background: According to world statistics, approximately 20% of adults from the whole population are diagnosed with asymptomatic or silent gallstones in the United States of America and Europe. However, among these 20 percent of people, only a small percent develop complications or symptoms. Due to this, "silent" is the term assigned to most of these gallstones because they are often identified during abdominal investigations that were performed for other purposes.Objective: This research was performed to identify the association between biliary pancreatitis and silent gallstones.Study design: a cross-sectional studyPlace and Duration:This study was conducted at Liaquat University of Medical and Health Sciences Jamshoro fromOctober 2022 to March 2023.Methodology: The people who were involved in this research were those who were diagnosed with acute pancreatitis associated with silent gallstones. All the participants were of both genders and all ages. The most common thing that the participants complained about was pain in the upper abdomen, which spread to the back as well for about one to two weeks duration. The silent gallstones were confirmed using ultrasonography
Relationship of Gall stone with Severity of Acute Pancreatitis
Background: Acute pancreatitis is now the most common reason for hospital admission among all gastrointestinal disorders. In most countries the presence of gallbladder stones represents the most frequent and significant risk factors for developing acute pancreatitis and underlying gallstone disease accounts for between 30 and 50% of cases with pancreatitis. Little is known about whether the severity of pancreatitis depends upon persistent stone impaction or stone passage into the duodenum. Multiple theories have been proposed to describe how gallstones set off the inflammatory response in acute pancreatitis, and a commonly accepted mechanism involves a transient obstruction of the bile or pancreatic duct by an impacted or passing stone. Objective: In our study we aimed to assess the relationship of gall stone with severity of acute Pancreatitis. The others specific objectives were to find out the prevalence of acute pancreatitis in patients who presented with sudden attack of upper abdominal pain as well its etiological factors and complications. Methodology: All patients admitted with acute attack of upper abdominal pain were considered as target population from which the study population was purposively selected after clinical and biochemical confirmation of acute pancreatitis. Severity was assessed by Ranson score. This observational study was carried out from January 2018 to December 2018 at Enam Medical College and Hospital, Savar. Statistical analysis was carried out by Student's t-Test. Results: Total 187 patients got admitted within above mentioned time span with acute attack of upper abdominal pain. The prevalence of acute pancreatitis among them was 30% (56). Majority of the age group (40%) belonged to 41-50 year. Gall stone was the most common etiological factors in our study (38%). Idiopathic being the next common (27%). Based on Ranson score 17 patients had severe attack. Pleural effusion developed in 60% of the patients and 2 patients died due to MODS. The severity of pancreatitis was not statistically related to the presence of gall stones (p value 0.3). Conclusion: In our study though gallstone being the most common etiological factor it was not related to the severity of acute pancreatitis. So the presence of gallstones should not be considered to assess the severity of the disease.
International Surgery Journal
Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservativel...
Management guidelines for gallstone pancreatitis. Are the targets achievable?
JOP : Journal of the pancreas, 2009
Current management of gallstone pancreatitis in a university hospital. Comparison of current management of gallstone pancreatitis with recommendations in national guidelines. Tertiary care centre in Scotland. One-hundred consecutive patients admitted with gallstone pancreatitis. All patients that presented with gallstone pancreatitis over a 4-year period were audited retrospectively. Data were collated for radiological diagnosis within 48 hours, ERCP within 72 hours, CT at 6-10 days, and use of high-dependency or intensive therapy units in severe gallstone pancreatitis, and definitive treatment of gallstone pancreatitis within 2 weeks as recommended in national guidelines. Forty-six patients had severe gallstone pancreatitis and 54 patients mild pancreatitis. Etiology was established within 48 hours in 92 patients. Six (13.0%) out of the patients with severe gallstone pancreatitis were managed in a high dependency unit. Fifteen (32.6%) patients with severe gallstone pancreatitis und...
Gallstone Pancreatitis Without Cholecystectomy
JAMA Surgery, 2013
IMPORTANCE Current guidelines recommend that patients with an initial episode of gallstone pancreatitis receive cholecystectomy. However, for various reasons, many patients do not. OBJECTIVE To determine the risk of developing recurrent gallstone pancreatitis in patients who never receive a cholecystectomy. DESIGN Retrospective cohort study using electronic medical records. SETTING Inpatient and outpatient. PATIENTS All patients in Kaiser Permanente Southern California with a primary diagnosis of acute gallstone pancreatitis hospitalized from January 1, 1995, through December 31, 2010, with no previous diagnosis of gallstone pancreatitis documented in the medical record. INTERVENTIONS Endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy and/or stent placement, or no intervention. MAIN OUTCOMES AND MEASURES Recurrent acute pancreatitis. RESULTS A total of 1119 patients were identified. The median age at diagnosis was 63 years. Among the patients, 802 received no intervention and 317 received ERCP. After a median follow-up of 2.3 years, the overall risk of recurrent pancreatitis was 14.6%; it was 8.2% and 17.1% in patients who had ERCP and no intervention, respectively (P < .001). The median time to recurrence was 11.3 and 10.1 months in the patients who had ERCP and no intervention, respectively. Kaplan-Meier estimates of recurrence for 1, 2, and 5 years in the ERCP group were 5.2%, 7.4%, and 11.1%, compared with 11.3%, 16.1%, and 22.7% in the no-intervention group (hazard ratio = 0.45; 95% CI, 0.30-0.69; P < .001). Charlson Comorbidity Index and intensive care unit stay were independently associated with recurrence, whereas age, sex, and admission Ranson score were not associated. CONCLUSIONS AND RELEVANCE In patients who did not undergo cholecystectomy, the risk of recurrent pancreatitis is significant. Endoscopic retrograde cholangiopancreatography mitigates this risk and should be considered during initial hospitalization if cholecystectomy is not done.