Jssn Vol 17 No1_final to print copy.pdf


11JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Presence of choledocholithiasis in patients undergoing 

cholecystectomy for mild biliary pancreatitis

Pradhan S1, Shah S2, Maharjan S2, Shah JN3

1

2

2

3 Professor, Patan hospital

Correspondence: 

Introduction: 

Methods:  Patients admitted in the surgical ward in Patan hospital with the diagnosis of mild acute 

Results:

negative exploration.

Conclusions:

Keywords: Biliary pancreatitis; Choledocholithiasis; Intra operative cholangiogram.

Introduction

clinical course of pancreatitis is usually self-limited and 

1

times higher than in comparison to the general population.2

Because of this, treatment usually includes cholecystectomy 

evaluation and treatment of persistent choledocholithiasis. 

Original Article



12JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

3

who form the larger group, after recovering from an episode 

Intra-operative cholangiogram (IOC) is a widely used 

performing routine IOC.

addressed in literature however it is well accepted that 

exploration.

Methods

with intra-operative cholangiography during the study 

period were included in the study. Patient who underwent 

than threefold rise in serum amylase, visualization of 

 Mild acute 

pancreatitis associated with minimal dysfunction, 

uneventful recovery with prompt normalization of physical 

local complications.  Pancreatitis was considered resolved 

repeated in the immediate preoperative period and surgery 

was performed only if they were in decreasing trend to 

considered dilated.

underwent open cholecystectomy with IOC. The IOC was 

head up and left lateral position. Films were immediately 

performed. IOC was repeated if dye did not reach the 

duodenum in spite of injection Buscopan

as one or more of the following

th post operative day. 



13JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Microsoft excel software.8

Results

Open cholecystectomy with IOC was performed in the same 

acute pancreatitis and eight had past history of jaundice. 

There was no failed IOC.

Table 1: Surgical management of patients with resolving 

mild acute biliary pancreatitis (n=52)

Name of surgery Numbers Percentage (%)

Cholecystectomy

with IOC
92.31

Open

cholecystectomy

with IOC and 

Total 52 100

cases the cystic duct was opened directly into the right 

th post 

nd

symptoms of retained stones were found post-operatively. 

reoperation in 12 months follow up period.

Discussion

pancreatitis cases annually. Traditional teaching indicates 

IOC in all patients undergoing cholecystectomy following 

stones remain in the common duct.9 Facilities for immediate 

study and the patients in our setting are usually from low 

which is expensive in comparison to routine IOC. Thus 

as a part of the usual treatment of gallstone pancreatitis, 

routine IOC at the time of cholecystectomy was performed 

choledocholithiasis.

gallstone pancreatitis who underwent IOC does not differ 

acute gallstone pancreatitis undergoing cholecystectomy 

stone.11 Our study shows that patients recovering from acute 

gallstone pancreatitis who undergo cholecystectomy after 

increases with increases in the preoperative time interval, 

12  The mean length of hospitalization 

from admission to cholecystectomy was around seven 



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

13

and his team who reviewed the diagnostic accuracy of 

IOC in cases highly suggestive of choledocholithiasis.

There were three false positive cases and one case of false 

patients with a history of pancreatitis. They concluded that 

In

to identify one case of choledocholithiasis. Suits et al 

patients with symptomatic gallstone disease.  These data 

pass spontaneously and thus IOC for every case of mild 

of IOC, past history of pancreatitis was associated with 

of detection.

a previous history of jaundice, elevated liver function test, 

Limitations of this research

Conclusion

pancreatitis.

References

1.

2.

pancreatitis and relationship with cholecystectomy or 

3.

cholangiopancreatography in gallstone-associated 

9 .



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

8.

9.

the incidence of cholangitis and clinical predictors 

11.

intraoperative cholangiogram in the management of 

12.

13. Korman J, Cosgrove J, Furman M, Nathan I, 

Cohen J. The role of endoscopic retrograde 

cholangiopancreatography and cholangiography in the