The presence of the gallbladder is associated with the severity of acute biliary pancreatitis.
CONCLUSIONS
The presence of the gallbladder at the onset of acute biliary 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 gallstone through the ampulla.


BACKGROUND
In clinical practice there is an impression that the presence of the gallbladder in patients with biliary pancreatitis may be associated with increased severity of the disease, compared to patients who have undergone cholecystectomy.


METHODS
To test this hypothesis, we studied 266 cases with biliary pancreatitis. Patients were divided into two groups: (A) those who had a gallbladder in situ at the onset of biliary pancreatitis (n = 234, 88%) and (B) those who had undergone previous cholecystectomy (n = 32, 12%).


RESULTS
Pancreatitis was more severe in group A than in group B, according to Glasgow criteria (> or = 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.
Räty
S
S
Department of Surgery, Tampere University Hospital, Finland.
Jaakkola
M
M
Karjalainen
J
J
Kuivanen
H
H
Sand
J
J
Nordback
I
I
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002763:Cholecystectomy; D005260:Female; D005387:Finland; D005704:Gallbladder / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000209:etiology* / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies
D002097:C-Reactive Protein