Cholangiography and endoscopic sphincterotomy in the management of severe acute gallstone pancreatitis discovered at diag~osticlaparotomy
Seven patients with gallstone pancreatitis discovered at diagnostic laparotomy did not undergo definitive biliary surgery because it was considered hazardous in the presence of severe acute pancreatitis. The procedures carried out at operation in these cases Included cholecystectomy and Ttube drainage (2 patients) cholecystostomy drainage (3 patients), and closure of the abdomen without drainage (2 patients). Direct cholangiography was carried out postoperatively in all cases. The biliary drain was used for this purpose in 5 patients, and endoscopic retrograde cholanglopancreatography was performed In 2. All patients were found to have calculi In the common bile duct and were successfully managed by endoscopic sphincterotomy (ES) without complications or mortality. ES therefore appears to be a safe and effective method of avoiding difficult and hazardous biliary surgery in the presence of severe acute pancreatitis.
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