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Choledocholithiasis in Acute Gallstone Pancreatitis: Incidence and Clinical Significance

Choledocholithiasis in Acute Gallstone Pancreatitis: Incidence and Clinical Significance Abstract • A prospective study of choledocholithiasis was performed using 110 patients with presumptive diagnoses of acute gallstone pancreatitis. The incidence of migrating and persistent bile duct stones was determined using stool screening and intraoperative cholangiography, and the clinical significance of continued stone obstruction of the papilla was investigated using ultrasound assessment of migration time and a second evaluation of prognostic signs. Pancreatic inflammation was confirmed at surgery in 51 patients, of whom only 27 had stones in the stools (n = 22) or the bile duct (n = 5), suggesting that choledocholithiasis may not be the sole triggering factor of acute gallstone pancreatitis. Neither delayed migration nor persistent stone obstruction of the papilla promoted pancreatic inflammation. (Arch Surg. 1991;126:566-568) References 1. Steer ML. Classification and pathogenesis of pancreatitis . Surg Clin North Am . 1989;69:467-480. 2. Howard JM. Gallstone pancreatitis . In: Howard JM, Jordan GL, Reber HA. Surgical Diseases of the Pancreas . Philadelphia, Pa: Lea & Febiger; 1987:265-283. 3. Acosta JM, Ledesma CL. Gallstone migration as a cause of acute pancreatitis . N Engl J Med . 1974;290:484-487.Crossref 4. Kelly TR. Gallstone pancreatitis: pathophysiology . Surgery . 1976;80:488-492. 5. Kelly TR. Gallstone pancreatitis: the timing of surgery . Surgery . 1980;88:345-350. 6. Acosta JM, Pellegrini CA, Skinner DB. Etiology and pathogenesis of acute biliary pancreatitis . Surgery . 1980;88:118-125. 7. Acosta JM, Rossi L, Ledesma CL. The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis: a description of the technique . Dig Dis Sci . 1977;22:168-172.Crossref 8. Oría A, Alvarez J, Chiappetta L, et al. Risk factors for acute pancreatitis in patients with migrating gallstones . Arch Surg . 1989;124:1295-1296.Crossref 9. Oría A, Frider B, Alvarez J, Chiappetta L, Souto N, Fontana JJ. Biliary and pancreatic obstruction during gallstone migration . Int J Pancreatol . 1988;3:157-164. 10. Ranson JHC. The timing of biliary surgery in acute pancreatitis . Ann Surg . 1979;89:654-662.Crossref 11. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: value of CT in establishing prognosis . Radiology . 1990;174:331-336.Crossref 12. Neoptolemos JP, Carr-Locke DL, London N, Bailey I, Fossard DP. ERCP findings and the role of endoscopic sphincterotomy in acute gallstone pancreatitis . Br J Surg . 1988;75:954-960.Crossref 13. Kim U, Shen HY, Bodner B. Timing of surgery for acute gallstone pancreatitis . Am J Surg . 1988;156:393-396.Crossref 14. Barraya L, Pujol Soler C, Yvergneaux JP. La région oddienne: anatomie millimétrique . Nouv Presse Med . 1971;79:2527-2534. 15. Coppa GF, LeFleur R, Ranson JHC. The role of Chiba-needle cholangiography in the diagnosis of possible acute pancreatitis with cholelithiasis . Ann Surg . 1981;193:393-398.Crossref 16. Kelly TR, Wagner DS. Gallstone pancreatitis: a prospective randomized trial of the timing of surgery . Surgery . 1988;104:600-605. 17. Zimmon D. What is the role of endoscopy in the management of biliary pancreatitis, and when should it be utilized? Am J Gastroenterol . 1990;85:9-10. 18. Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones . Lancet . 1988;2:979-983.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Choledocholithiasis in Acute Gallstone Pancreatitis: Incidence and Clinical Significance

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410290038007
Publisher site
See Article on Publisher Site

Abstract

Abstract • A prospective study of choledocholithiasis was performed using 110 patients with presumptive diagnoses of acute gallstone pancreatitis. The incidence of migrating and persistent bile duct stones was determined using stool screening and intraoperative cholangiography, and the clinical significance of continued stone obstruction of the papilla was investigated using ultrasound assessment of migration time and a second evaluation of prognostic signs. Pancreatic inflammation was confirmed at surgery in 51 patients, of whom only 27 had stones in the stools (n = 22) or the bile duct (n = 5), suggesting that choledocholithiasis may not be the sole triggering factor of acute gallstone pancreatitis. Neither delayed migration nor persistent stone obstruction of the papilla promoted pancreatic inflammation. (Arch Surg. 1991;126:566-568) References 1. Steer ML. Classification and pathogenesis of pancreatitis . Surg Clin North Am . 1989;69:467-480. 2. Howard JM. Gallstone pancreatitis . In: Howard JM, Jordan GL, Reber HA. Surgical Diseases of the Pancreas . Philadelphia, Pa: Lea & Febiger; 1987:265-283. 3. Acosta JM, Ledesma CL. Gallstone migration as a cause of acute pancreatitis . N Engl J Med . 1974;290:484-487.Crossref 4. Kelly TR. Gallstone pancreatitis: pathophysiology . Surgery . 1976;80:488-492. 5. Kelly TR. Gallstone pancreatitis: the timing of surgery . Surgery . 1980;88:345-350. 6. Acosta JM, Pellegrini CA, Skinner DB. Etiology and pathogenesis of acute biliary pancreatitis . Surgery . 1980;88:118-125. 7. Acosta JM, Rossi L, Ledesma CL. The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis: a description of the technique . Dig Dis Sci . 1977;22:168-172.Crossref 8. Oría A, Alvarez J, Chiappetta L, et al. Risk factors for acute pancreatitis in patients with migrating gallstones . Arch Surg . 1989;124:1295-1296.Crossref 9. Oría A, Frider B, Alvarez J, Chiappetta L, Souto N, Fontana JJ. Biliary and pancreatic obstruction during gallstone migration . Int J Pancreatol . 1988;3:157-164. 10. Ranson JHC. The timing of biliary surgery in acute pancreatitis . Ann Surg . 1979;89:654-662.Crossref 11. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: value of CT in establishing prognosis . Radiology . 1990;174:331-336.Crossref 12. Neoptolemos JP, Carr-Locke DL, London N, Bailey I, Fossard DP. ERCP findings and the role of endoscopic sphincterotomy in acute gallstone pancreatitis . Br J Surg . 1988;75:954-960.Crossref 13. Kim U, Shen HY, Bodner B. Timing of surgery for acute gallstone pancreatitis . Am J Surg . 1988;156:393-396.Crossref 14. Barraya L, Pujol Soler C, Yvergneaux JP. La région oddienne: anatomie millimétrique . Nouv Presse Med . 1971;79:2527-2534. 15. Coppa GF, LeFleur R, Ranson JHC. The role of Chiba-needle cholangiography in the diagnosis of possible acute pancreatitis with cholelithiasis . Ann Surg . 1981;193:393-398.Crossref 16. Kelly TR, Wagner DS. Gallstone pancreatitis: a prospective randomized trial of the timing of surgery . Surgery . 1988;104:600-605. 17. Zimmon D. What is the role of endoscopy in the management of biliary pancreatitis, and when should it be utilized? Am J Gastroenterol . 1990;85:9-10. 18. Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones . Lancet . 1988;2:979-983.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1991

References