Defining a therapeutic program for recurrent acute pancreatitis patients with unknown etiology.
OBJECTIVE
To define a therapeutic program for mild-moderate acute pancreatitis (AP), often recurrent, which at the end of the diagnostic process remains of undefined etiology.


METHODS
In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined.


RESULTS
Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs), 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES) in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence.


CONCLUSIONS
The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.
General Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Vincenzo
V
Neri
General Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Francesco
F
Lapolla
General Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Alessandra
A
Di Lascia
General Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Libero Luca
LL
Giambavicchio
ERCP/ES; acute pancreatitis; cholecystectomy; recurrent pancreatitis; unexplained etiology