Acute biliary pancreatitis: Staging and management

Background/Aims: Acute biliary pancreatitis is a clinical entity with a hig h morbidity rate (15-50%) and mortality rate (20-35%). Early diagnosis has a primary importance for an appropriate treatment (75% of cases of idiopath ic acute pancreatitis are of biliary origin). Methodology: Diagnosis of acute biliary pancreatitis in 78 patients was bas ed on careful clinical and instrumental assessment: ultrasonography (76.9% of cases) and laboratory tests in 23.1% of cases. In our study we used the Ranson and APACHE II scores and 24 of the cases (30.7%) were classified as severe, while 54 (69.2%) were mild. All patients with severe acute biliary pancreatitis underwent emergency endoscopic retrograde cholangiopancreatogr aphy + endoscopic sphincterotomy (within 24-48 hours) followed by laparosco pic cholecystectomy (10 days). Patients with mild acute biliary pancreatiti s underwent laparoscopic cholecystectomy associated with intraoperative cho langiography, within 10 days. Results: In 19 patients with severe acute biliary pancreatitis operative en doscopy was curative. Subsequent laparoscopic cholecystectomy provoked subc utaneous emphysema only in one case but did not show any other serious morb idity. In the remaining 5 cases laparotomy was required because of necrosis , with a mortality rate of 60%. In all cases of mild acute biliary pancreat itis, laparoscopic cholecystectomy was successfully performed with a morbid ity rate of 7.3%. Common bile duct stones were revealed with intraoperative cholangiography in 31.4% of the mild cases and in 75% of the severe cases. Conclusions: In conclusion acute biliary pancreatitis treatment is always s urgical; in almost all severe cases it is performed with minimally invasive procedures (endoscopic retrograde cholangiopancreatography + endoscopic sp hincterotomy with laparoscopic cholecystectomy less than or equal to 10 day s) if surgery is carried out within 24-48 hrs, as well in the mild cases (l aparoscopic cholecystectomy + intraoperative cholangiography) when surgery is performed within 10 days.