Recurrent Acute Gallstone Pancreatitis 10 Years after Cholecystectomy, a Rare Case Report

Hassan Mehmood^1, , NomanAhmed Jang Khan¹, Umer Farooq² and Khushbakht Ramsha Kamal³

¹Department of Internal Medicine, Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA

²Pakistan Institute of Medical Sciences, Islamabad, Pakistan

³Fatima Jinnah Medical University, Lahore, Pakistan

Cite this paper

Hassan Mehmood, NomanAhmed Jang Khan, Umer Farooq and Khushbakht Ramsha Kamal. Recurrent Acute Gallstone Pancreatitis 10 Years after Cholecystectomy, a Rare Case Report. American Journal of Medical Case Reports. 2017; 5(10):267-269. doi: 10.12691/AJMCR-5-10-5

Abstract

Alcohol intake and Gallstones account for more than two third cases of acute pancreatitis with gallstones solely responsible for 30 to 40 % of cases. We herein, present a rare case of acute pancreatitis in a 94 years old nonalcoholic male with past surgical history of cholecystectomy performed 10 years ago. Patient presented with acute epigastric pain, lipase of 1083 U/L, amylase of 1634 U/L, obstructive LFTs pattern and normal pancreas on CT abdomen. CA 19-9 was checked due to the patient’s recent weight loss and was found elevated at 420 U/ML. Patient’s symptoms resolved with conservative management in 2 days and lipase normalized. Considering his elevated CA 19-9 and recent weight loss, he was referred for endoscopic ultrasound as an outpatient for further workup. He presented again within 2 days of discharge with similar symptoms and lipase of 1100 U/L. Gastroenterology was consulted and ERCP performed which showed intrahepatic and extrahepatic bile duct dilatation with a filling defect in the distal common bile duct. Multiple stones measuring 2-4 mm were removed along with some biliary sludge and the symptoms resolved right away. The lipase level normalized and CA 19-9 dropped down dramatically to 42 U/ML. Although the incidence of recurrent choledocholithiasis after cholecystectomy is 2 to 10 %, the diagnosis of acute pancreatitis secondary to recurrent choledocholithiasis with elevated CA 19-9 can easily be missed in post cholecystectomy patients. Our patient’s presentation is unique that he developed acute gallstone pancreatitis secondary to CBD stones 10 years after cholecystectomy.

Keywords

pancreatitis, cholecystectomy, gall stone, amylase, lipase

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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