Diagnostic evaluation prior to cholecystectomy in mild-moderate acute biliary pancreatitis

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COD: 05_2009_363-368 Categorie: ,

Vincenzo Neri, Alberto Fersini, Antonio Ambrosi, Nicola Tartaglia, Tiziano Pio Valentino

Ann. Ital. Chir., 2009; 80: 363-367

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OBJECTIVES: The importance of papillary obstruction in the pathogenesis of acute biliary pancreatitis (ABP) is widely
recognized. The aim of this study was to evaluate the usefulness of the MRCP before the VLC in the patients with mild
acute biliary pancreatitis.
METHODS :In the period 2003-2008, 47 patients were submitted to a MRCP (F/M: 28/19) with mild ABP without
increase of the cholestasis tests and absence of choledocholithiasis at the abdominal US. During a follow up from 30 to
60 days after the VLC, the presence of jaundice or relapse of ABP were evaluated in all patients.
RESULTS: Thirteen patients had diagnosis of choledocholithiasis at the MRCP and they were submitted to an ERCP,
endoscopic sphincterotomy and stones removal; 34 patients with a negative MRCP were submitted to the VLC. Among
these, on 10th postoperative days, one patient has had recurrent ABP, and was submitted to ERCP/ES. All the 47 patients
submitted to the MRCP before the VLC did not have jaundice or relapse of the ABP during the follow-up period.
CONCLUSION: The MRCP was an accurate investigation for the preoperatory diagnosis of choledocholithiasis; even if it
is not possible to recommend its utilization extensively, it is an important procedure for the patients with diagnosis of
mild ABP to select all those to submit to the ERCP.

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