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

摘要

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.