Tanveer Alam, Jamaluddin M, Bushra Tasneem, Abbas S M.
Role of surgery in acute pancreatitis associated with calculus cholecystitis.
Pak J Surg Jan ;24(2):87-91.

Objective: To study the role of emergency and elective surgery in the management of acute pancreatitis due to gall stone disease in our setup. Design & Duration: Quasi experimental study from April 2004 to March 2006. Setting: Surgical Unit I, Abbasi Shaheed Hospital, Karachi. Patients: Twenty eight patients of acute pancreatitis with cholecystitis due to gall stone disease. Methodology: Apart from clinical workup and routine investigations in these patients, the diagnosis of acute pancreatitis was made on the basis of raised serum amylase (>1000 IU/L) in the presence of stones in the gall bladder or CBD on ultrasonography. Early surgery was performed in patients who did not improve within 48-72 hours of conservative management or those patients who requested for an early surgery, whereas late surgery was carried out in patients who responded well within 48-72. Results: Out of the total 28 patients of acute pancreatitis with calculus cholecystitis, 20 were female and eight male, with ages ranging from 24 to 71 years (mean age 47.50 years). Pain, nausea, vomiting, fever and tenderness in the upper abdomen were the presenting complaints. Elevated serum amylase levels ranged between 1000 to 9000 IU/L, though most (18) cases had serum amylase level between 1000 to 2000 IU/L. Gall stones were found in all the patients, while CBD stones were found in six (21.42%) and CBD sludge in one (3.57%) patient. Early surgery was carried out in 12 (42.85%) and late surgery in 11 (39.28%) patients; three (10.71%) cases did not return for late surgery while two (07.14%) died due to complications of pancreatitis. The minimum hospital stay was two days and maximum 27 days; mean stay was 14.50 days. Conclusion: Gall stones are the most common aetiological factor of acute pancreatitis in our society and patients having CBD stones are more prone to develop the disease. Most patients responded well to conservative management, though early surgery is quite safe, prevents recurrences and reduces the total hospital stay.

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