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ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 12-17

Role of hepatobiliary tract anatomy and morphology of gallstones in causation of acute pancreatitis


1 Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
3 Department of Physiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Correspondence Address:
Bhavesh Devkaran
Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3846.132896

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Introduction: Gall stone disease is a common cause of acute pancreatitis. At present the pattern of gall stones complication are largely unpredictable. Little research has been done to identify gall stone morphology and biliary tract anatomy in the causation of gall stone induced pancreatitis. Aims and Objectives: The present study was done at IGMC Shimla to study the relationship of gallstone characteristics to the risk of gall stone pancreatitis and to compare and evaluate the biliary tract anatomy in patients of gall stone induced pancreatitis and cholelithiasis by MRCP. Materials and Methods: The prospective study included 25 patients each of symptomatic cholelithiasis and gall stone induced pancreatitis divided into Group A and Group B respectively. All the patients were subjected to MRCP preoperatively. All the patients were operated by laproscopic or open method. Postoperatively the gall stone were collected and analyzed. Results: On MRCP- In Group A Single calculus was present in 11 (44%) patients and 1 (4%) patients had associated sludge, 14 (56%) patients had multiple calculi and 3 (44%) patients had associated sludge.In Group B 22 (88%) patients had multiple calculi and 16 (56%) patients had associated sludge, 3 (12%) patients had single stone, and 2 (8%) patients had associated sludge. In Group A, CBD stones were seen in 3 (12%) patients, cystic duct diameter ranged from 3 mm to 5.2 mm, CBD diameter ranged from 5 mm to 9 mm and pancreatic duct diameter ranged from 2.7 mm to 4 mm.In Group B, CBD stones were seen in 7 (28%) patients, cystic duct diameter ranged from 4 mm to 6.4 mm, CBD diameter ranged from 5 mm to 12 mm and pancreatic duct diameter ranged from 2.6 mm to 4.8 mm In Group A, Common channel was seen in 8 (32%) patients. In Group B, Common channel was seen in 18 (72%) patients Gall Stone Morphology- In Group A, Single calculus present in 11 (44%) patients and 1 (4%) patient had associated sludge. Multiple calculi present in 14 (56%) patients and 3 (12%) patients had associated sludge. In Group B, Single calculus present in 3 (12%) patients and 2 (8%) patients had associated sludge. In group A, 15 (60%) patients had round stones and 14 (56%) patients had multifaceted stones and 6 (24%) patients had associated sludge. In Group B, 5 (20%) patients had round stones and 14 (56%) patients has multifaceted stones and 6 (24%) patients had associated sludge. Sludge <2 mm diameter was present in 6 patients each in Group A and B. Weight ranged from 2 to 3.8 gm in Group A and in Group B from 1.6 to 3.25gm. Conclusion: The present study clearly established an association between multiple, multifaceted stones, sludge, wide cystic duct and presence of common channel with increased incidence of Gallstone induced pancreatitis, MRCP also proved to be an excellent diagnostic modality in Gall stone induced pancreatitis.


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