THE PRESENCE OF THE GALLBLADDER IS ASSOCIATED WITH THE SEVERITY OF ACUTE BILIARY PANCREATITIS

Conclusion. The presence of the gallbladder at the onset of acute bili ary pancreatitis is associated with increased severity of the disease. One possible explanation is that gallbladder contraction might induce bile reflux into the pancreatic duct during the transfer of a gallsto ne through the ampulla. Background. In clinical practice there is an i mpression that the presence of the gallbladder in patients with biliar y pancreatitis may be associated with increased severity of the diseas e, compared to patients who have undergone cholecystectomy. Methods. T o test this hypothesis, we studied 266 cases with biliary pancreatitis . Patients were divided into two groups: (A) those who had a gallbladd er in situ at the onset of biliary pancreatitis (n = 234, 88%) and (B) those who had undergone previous cholecystectomy (n = 32, 12%). Resul ts. Pancreatitis was more severe in group A than in group B, according to Glasgow criteria (greater than or equal to 3 positive, 66/210 = 31 % vs 4/29 = 14%,p = 0.04); development of complications (77/234 = 33% vs 4/32 = 13%, p = 0.01); and mortality (40/234 = 17% vs 1/32 = 3%,p = 0.03). Furthermore, serum C-reactive protein levels on admission were over 150 mg/L twice as often in group A as in group B.