THE TREATMENT OF GALLSTONE ASSOCIATED PANCREATITIS

Abstract

Gallstone-associated pancreatitis constitutes more than fiftyper cent of cases with acute pancreatitis in Turkey. The treatment results of 86 patients (65 female and 21 male) with 87 acute attacks of gallstone pancreatitis were analyzed in this study. The course of disease was mild in 75 cases (86.2%) and severe in 12 (13.8%).

Initial and repeated ultrasonographic examinations revealed gallbladder stones in 68 (83.9%) and 72 (88.9%) patients respectively.

Preoperative ultrasonography demonstrated features of gallstone in on/y 3 of 9 patients with common bite duct stone.

Initial ultrasonography revealed pathologic changes in 35, nonvisualization of pancreas in 24 and normal findings in 28 patients with acute pancreatitis.

Of the 86 patients; 73 underwent conservative and surgical treatment (elective and 3 emergency surgery). Thirteen patients were treated conservatively because of severe cardiac disease in 3, endoscopic sphincterotomy intervention in 3, objection of surgery in 6 and early hospital death in one patient.

Six patients died (7%) in these series. Mortality rate was 7.3% for mild and 41.7% for severe cases. Mild cases can be managed with initial conservative and subsequent relapse preventing biliary surgery with very low mortality and morbidity.

The main factor responsible for the high mortality and treatment failure in severe acute pancreatitis is the developing infected pancreatic necrosis which induces multiple system organ failure.