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

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