Optimal timing of surgical intervention in patients with acute pancreatitis associated with cholelithiasis.

In evaluating patients with acute pancreatitis, disproportionately high serum amylase values in comparison to physical findings of peritonitis of the upper part of the abdomen and the rapid return to normal values and the lack of a history of alcohol ingestion should be viewed as findings highly indicative of pancreatitis associated with cholelithiasis. Diagnostic roentgenologic procedures can be initiated soon after admission of the patient, with an intravenous cholangiogram or oral cholecystogram, depending upon the feasibility of oral intake, in patients without jaundice. Expectant treatment is both safe and preferable, so that surgical treatment for disease of the biliary tract is performed after the diagnosis is established in the same hospitalization period.