Cholelithiasis and acute pancreatitis

In acute biliary pancreatitis it is the acute inflammatory pancreatitis rather than the cholelithiasis which dominates. Among 2161 patients with cholelithiasis seen from 1972 to 1983, 21% were found to have choledochal stones at operation. A total of 121 patients (5.6%) had "associated pancreatitis" according to the history as well as clinical and intra-operative findings. Frequency and site of cholelithiasis, as well as treatment and its results were compared with those in a group of patients with "acute pancreatitis of biliary origin" (145 of 447 patients from 1972 to 1983). Choledocholithiasis occurred equally often in both groups (36-39%). Impacted papillary concrements were found in 2.9% of patients with acute biliary pancreatitis, in 7.4% of those with "associated pancreatitis". Early intervention is practised only in case of impacted papillary stones, preferably by endoscopic papillotomy. Otherwise the timing of any operative procedure will be determined entirely by the severity and course of the acute pancreatitis.