Early abdominal CT examination in decision making on diagnosis and treatment of acute biliary pancreatitis

doi:10.16139/j.1007-9610.2019.03.013

Abstract

Abstract: Objective To study the effect of early abdominal CT examination in decisions making on diagnosis and treatment of acute biliary pancreatitis (ABP). Methods From January 1, 2013 to December 30, 2016, consecutively admitted ABP patients within 48 hours of onset were enrolled and abdominal CT scan was performed to diagnose peripancreatic fluid collection, gallbladder stones, and common bile duct stones. ABP patients with neither peripancreatic fluid collection (mild type of Balthazar CT grade) nor organ dysfunction (Marshall score <2 ) were divided into 2 groups: early laparoscopic cholecystectomy (ELC) group and late laparoscopic cholecystectomy (LLC) group. Patients in ELC group had laparoscopic cholecystectomy (LC) during the period of 7 days after onset when abdominal pain was relieved and laboratory tests improved, but still in the fasting period. Patients in LLC group had LC at the onset 7 days later when no abdominal pain and normal laboratory test after treatment were found and fluid food at least 2 days without discomfort. If common bile duct stones was diagnosed by CT, endoscopic retrograde cholangiopancreatography (ERCP) with stone removal was done before LC. Results A total of 115 cases were eligible for inclusion in this study. There were 56 cases in ELC group and 59 cases in LLC group. Sensitivity of abdominal CT scan for diagnosis of gallbladder stones and common bile duct stones was >; 85%, and specificity 100%. ERCP with stone removal was performed for 44 cases combined endoscopic nasal bile duct drainage. All patients were cured and discharged without any complications including abdominal hemorrhage or infection, bile leakage, and no postoperative exacerbation of pancreatitis. Length of hospital stay, days before LC and LC operative time in ELC group were significantly less than those in LLC group, P< 0.05. There were no significant differences in operative blood loss between 2 groups and no bile duct injuries occurred. One case was converted to open surgery in LLC group. Conclusions Early abdominal CT would be instructive for the treatment options of ABP. ERCP with stone removal should be performed timely for the patients with common bile duct stones and ELC could be safely performed for the patients with neither peripancreatic fluid collection nor organ dysfunction to shorten hospital stay significantly.

Key words: Acute biliary pancreatitis, Computed tomography, Laparoscopic cholecystectomy

CLC Number:

R657.5⁺1

YAO Wei, KONG Lei, WU Qinghua, LU Yifan, YE Jinhua, ZHAO Liangchao, XU Jingci, LI Nengping. Early abdominal CT examination in decision making on diagnosis and treatment of acute biliary pancreatitis[J]. Journal of Surgery Concepts & Practice, 2019, 24(03): 236-241.

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