American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Medical Case Reports. 2017, 5(10), 267-269
DOI: 10.12691/ajmcr-5-10-5
Open AccessCase Report

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

Hassan Mehmood1, , 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

Pub. Date: October 28, 2017

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


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.

pancreatitis cholecystectomy gall stone amylase lipase

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Satoh K, Shimosegawa T, Masamune A, Hirota M, Kikuta K, Kihara Y, Kuriyama S, Tsuji I, Satoh A, Hamada S, Research Committee of Intractable Diseases of the Pancreas. Nationwide epidemiological survey of acute pancreatitis in Japan. Pancreas. 2011 May 1; 40(4): 503-7.
[2]  Shen HN, Lu CL, Li CY. Epidemiology of first-attack acute pancreatitis in Taiwan from 2000 through 2009: a nationwide population-based study. Pancreas. 2012 Jul 1; 41(5): 696-702.
[3]  Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Gastroenterology-Orlando. 2007 May 1; 132(5): 2022-44.
[4]  Tanaka M, Ikeda S, Yoshimoto H, Matsumoto S. The long-term fate of the gallbladder after endoscopic sphincterotomy: complete follow-up study of 122 patients. The American journal of surgery. 1987 Nov 1; 154(5): 505-9.
[5]  Oak JH, Paik CN, Chung WC, Lee KM, Yang JM. Risk factors for recurrence of symptomatic common bile duct stones after cholecystectomy. Gastroenterology research and practice. 2012 Sep 6; 2012.
[6]  Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN, Huibregtse K. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointestinal endoscopy. 1996 Dec 31; 44(6): 643-9.
[7]  Ando T, Tsuyuguchi T, Okugawa T, Saito M, Ishihara T, Yamaguchi T, Saisho H. Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut. 2003 Jan 1; 52(1): 116-21.
[8]  Kim DI, Kim MH, Lee SK, Seo DW, Choi WB, Lee SS, Park HJ, Joo YH, Yoo KS, Kim HJ, Min YI. Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy. Gastrointestinal endoscopy. 2001 Jul 31; 54(1): 42-8.
[9]  Pereira-Lima JC, Jakobs R, Winter UH, Benz C, Martin WR, Adamek HE, Riemann JF. Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms. Gastrointestinal endoscopy. 1998 Nov 30; 48(5): 457-64.
[10]  Hofmeyr S, Meyer C, Warren BL. Serum lipase should be the laboratory test of choice for suspected acute pancreatitis. South African Journal of Surgery. 2014 Aug; 52(3): 72-5.
[11]  E Poruk K, Z Gay D, Brown K, D Mulvihill J, M Boucher K, L Scaife C, A Firpo M, J Mulvihill S. The clinical utility of CA 19-9 in pancreatic adenocarcinoma: diagnostic and prognostic updates. Current molecular medicine. 2013 Mar 1; 13(3): 340-51.
[12]  Carioca AL, Jozala DR, Bem LO, Rodrigues JM. Severity assessment of acute pancreatitis: applying Marshall scoring system. Revista do Colégio Brasileiro de Cirurgiões. 2015 Oct; 42(5): 325-7.
[13]  Fu CY, Yeh CN, Hsu JT, Jan YY, Hwang TL. Timing of mortality in severe acute pancreatitis: experience from 643 patients. World journal of gastroenterology. 2007 Apr 7; 13(13): 1966.