Biliary pancreatitis: clinical presentation and surgical management.

The presentation, surgical management, and clinical outcome in 153 patients with biliary pancreatitis has been reviewed. Only 37 percent of our patients demonstrated any of Ranson's 11 prognostic signs of severe pancreatitis, and only 3 percent had 3 or more signs. Fourteen patients underwent emergency operation within 48 hours of admission, 108 underwent briefly delayed operation during the same hospitalization, and 31 were discharged and scheduled for elective cholecystectomy 6 weeks after admission. The biliary pancreatitis grew worse in 7 of 114 patients during initial medical management and required emergency operation, and 81 percent underwent elective surgery within 10 days of admission. When patients were discharged before cholecystectomy, the recurrence rate of acute biliary pancreatitis that required emergency readmission was unacceptably high (61 percent). There was no statistical difference in total number of hospital days, number of intensive care unit days, or mortality between the three groups. Our study suggests that emergency operation with decompression of the ampulla of Vater is unnecessary in patients with biliary pancreatitis, and that briefly delayed operation during the same hospitalization can be performed safely after resolution of acute pancreatitis.