Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis

Background: Acute pancreatitis occurs in only 3-7% of patients with gallstones. But gallstones were implicated in about 27% cases of acute pancreatitis reported in a decade prior to 1980. The relative risk of developing acute pancreatitis varies from country to country, and within a given country it is influenced by socio-economic, ethnic, and cultural factors. The present study evaluated the incidence of the disease, age-sex distribution, clinical manifestations methods, and management of gallstone pancreatitis. Aim and objectives: To diagnose a case of gallstone pancreatitis by various investigations like blood investigations, USG or by CT scan, age-sex distribution, to observe the varied clinical presentations of biliary pancreatitis with regards to symptoms and signs, to study the management protocol of gallstone pancreatitis. Material and methods: 50 cases of gallstone pancreatitis were studied during the period from May 2012 to July 2014, from all surgical units at our institute. Inclusion criteria: All patients admitted in surgical wards in a given particular unit who have diagnosed as having gallstone pancreatitis. Exclusion criteria: Patients having pancreatitis other than biliary cause. This study included all the age groups and both the sex. Results: In our study, most (34%) of male patients at the age group of 50-70 years, biliary pancreatitis was more predominant. Most (34%) of female patients at the age group of 40-60 years had biliary pancreatitis. In our study, most (92%) of the patient’s serum amylase was 3 fold above normal value, alkaline phosphatase was raised in 88% of patients, 68% of them had increased AST, and 22% of them had had elevated serum bilirubin levels. Normal value of serum amylase ranges from 40 to 140 U/L, Alkaline phosphatase from 45 to 115 U/L and AST from 8 to 48 U/L. In our study, out of 50 patients, 28 patients underwent laparoscopic cholecystectomy and 8 patients underwent open cholecystectomy during same admission. In 9 patients endoscopic retrograde cholangiopancreatography (ERCP) plus endoscopic sphincterotomy (ES) was done and remaining patients managed conservatively. Conclusion: Gallstone pancreatitis represents the most severe form of disease. The diagnosis is based in history and physical examination, an elevation of serum amylase 3 fold above the normal level, and ultrasound and CT scans. Endoscopic retrograde cholangiopancreatography is one of the tools in less certain cases of the absence of an agent that can abort progression of the disease; therapy should consist of adequate resuscitation, nutritional support, and careful monitoring to detect early complications.