The natural course of acute gallstone pancreatitis.

Abstract

The aim of the study was to verify the hypothesis of complete recovery after acute gallstone pancreatitis (a.g.p) and to correlate findings of different diagnostic techniques. Thirty patients, aged 23-82 (mean 53.4 +/- 16.7), underwent a secretin-cerulein test (SCT), ultrasound (US) and computed tomography (CT) of the pancreas 6-12 months and 3-5 years after an attack of a.g.p. Exocrine pancreatic function impairment in SCT was found in 19 (63.3%) patients 6-12 months after a.g.p and in 9 (30%) patients 3-5 years after a.g.p. Imaging techniques revealed pancreatic structure abnormalities (pancreas enlargement, pseudocysts, Wirsung duct dilatation or calcifications) in 33.3% patients (US) and in 56.6% patients (CT) 6-12 months after a.g.p and in 13.3% (both US and CT) in patients 3-5 years after a.g.p. Nevertheless, the combination of recurrent attacks of abdominal pain, severe exocrine pancreatic function impairment requiring enzyme supplementation and pancreatic calcifications in imaging techniques 3-5 years after a.g.p. have been observed only in 4 (13.3%) patients. Those were the patients after multiple attacks of clinically severe, necrotic a.g.p., in which cholecystectomy has not been performed. We conclude that in most cases after acute gallstone pancreatitis pancreatic structure and function gradually return to normal. Nevertheless, patients after multiple episodes of clinically severe a.g.p., with gallbladder in situ should undergo a prospective pancreatic function and structure evaluation in order to early recognize and treat the revealed changes.