THE BEST MANAGEMENT FOR CRESCENDO BILIARY COLIC IS URGENT LAPAROSCOPIC CHOLECYSTECTOMY

Gallbladder disease due to stones is well recognised as falling into t wo categories, presenting with either chronic symptoms or developing a cute cholecystitis or other complications. We describe an intermediate group of 14 patients (11 women, three men, median age 31 years) prese nting with 4-14 days of at least daily attacks of resolving biliary co lic, who underwent early laparoscopic cholecystectomy within 24 hours of presentation. None had any evidence of acute inflammation, either a t laparoscopy or on histology. Their surgery was straightforward with operating times ranging from 35-80 minutes and no complications. Patie nts with 'crescendo biliary colic' are often young women who can rarel y afford invalidity. Rather than the current practice of analgesia for each attack and elective surgery weeks later, they are optimally mana ged by urgent laparoscopic cholecystectomy, preventing the development of complications and minimising the need for further medical involvem ent.