Learn more: PMC Disclaimer | PMC Copyright Notice
Gallstone pancreatitis. Local predisposing factors.
Abstract
Local predisposing anatomic and stone factors were studied in 150 patients with gallstones in order to analyze why some patients with cholelithiasis acquire gallstone pancreatitis and others do not. Number and size of gallstones in the gallbladder and common bile duct, presence of pancreatic duct reflux, diameter of the cystic duct, and size of the duodenal orifice and ampulla of Vater were all studied in 75 patients with gallstone pancreatitis (Group I), 75 patients with cholelithiasis (Group II), and by dissections in 50 autopsy specimens. Stones 5 mm or less in diameter were present in 51 (70%) of Group I gallbladders as compared to 30 (41%) of Group II patients (p less than 0.001). Impacted common bile duct stones were found in 21 (29%) of the Group I patients and only four (5%) of the patients in Group II (p less than 0.001). The mean size of the stones that impacted at the ampulla of Vater in the Group I patients were 3.10 mm, whereas in the Group II patients the mean size of the stones was 7.50 mm (p less than 0.001). The Group I cystic ducts were larger (3.80 mm) than the ducts in the Group II patients (2.36 mm) (p less than 0.001). On operative cholangiography, 50 (67%) showed reflux of contrast material into the pancreatic duct compared to only 14 (18%) in the control Group II (p less than 0.001). These data indicate that small gallbladder stones, enlarged cystic ducts, properly sized impacted stones, and a functioning common channel are predisposing local etiologic factors in the development of gallstone pancreatitis.
Full text
Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Kelly TR. Gallstone pancreatitis: pathophysiology. Surgery. 1976 Oct;80(4):488–492. [PubMed] [Google Scholar]
- Kelly TR. Gallstone pancreatitis: the timing of surgery. Surgery. 1980 Sep;88(3):345–350. [PubMed] [Google Scholar]
- Acosta JM, Ledesma CL. Gallstone migration as a cause of acute pancreatitis. N Engl J Med. 1974 Feb 28;290(9):484–487. [PubMed] [Google Scholar]
- Acosta JM, Rossi R, Galli OM, Pellegrini CA, Skinner DB. Early surgery for acute gallstone pancreatitis: evaluation of a systematic approach. Surgery. 1978 Apr;83(4):367–370. [PubMed] [Google Scholar]
- McMahon MJ, Shefta JR. Physical characteristics of gallstones and the calibre of the cystic duct in patients with acute pancreatitis. Br J Surg. 1980 Jan;67(1):6–9. [PubMed] [Google Scholar]
- McMahon MJ, Playforth MJ, Booth EW. Identification of risk factors for acute pancreatitis from routine radiological investigation of the biliary tract. Br J Surg. 1981 Jul;68(7):465–467. [PubMed] [Google Scholar]
- Taylor TV, Rimmer S. Pancreatic-duct reflux in patients with gallstone pancreatitis? Lancet. 1980 Apr 19;1(8173):848–850. [PubMed] [Google Scholar]
- Acosta JM, Pellegrini CA, Skinner DB. Etiology and pathogenesis of acute biliary pancreatitis. Surgery. 1980 Jul;88(1):118–125. [PubMed] [Google Scholar]
- STERLING JA. Significant facts concerning the papilla of Vater. Am J Dig Dis. 1953 May;20(5):124–126. [PubMed] [Google Scholar]
- Kelly TR, Swaney PE. Gallstone pancreatitis: the second time around. Surgery. 1982 Oct;92(4):571–575. [PubMed] [Google Scholar]