Gallstones and Acute Pancreatitis: Clinical Guidance and Imaging Tests for Acute Abdominal Pain

The relationship between gallstones and acute pancreatitis is a topic of great relevance in daily clinical practice. Gallstones are one of the most common causes of acute pancreatitis, a condition that can range from a mild episode to a severe illness with significant complications. Early identification and appropriate management are crucial to prevent disease progression and improve clinical outcomes.

Diving Deeper into the Relationship Between Gallstones and Acute Pancreatitis

Acute pancreatitis is characterized by inflammation of the pancreas, and gallstones are responsible for approximately 50% of cases of this disease. The obstruction of the bile duct by stones can lead to increased pressure in the pancreatic duct, triggering the inappropriate activation of pancreatic enzymes and, consequently, inflammation of the pancreas. Typical symptoms include acute abdominal pain, nausea, and vomiting, and are confirmed by elevated levels of enzymes such as amylase and lipase in serum [1].

The diagnosis and management of gallstone-induced acute pancreatitis require careful evaluation. Ultrasound is the initial imaging technique of choice to detect gallstones and assess the gallbladder. In cases of diagnostic uncertainty or to evaluate complications, computed tomography or magnetic resonance imaging may be employed [2]. Early cholecystectomy during the same hospitalization is recommended to prevent recurrences in cases of mild pancreatitis [3].

In more complex situations, such as the presence of cholangitis or persistent choledocholithiasis, endoscopic retrograde cholangiopancreatography (ERCP) may be necessary to relieve the bile duct obstruction [4]. The management of severe acute pancreatitis may require a multidisciplinary approach, including nutritional support and management of local and systemic complications [5].

Conclusions

The relationship between gallstones and acute pancreatitis underscores the importance of accurate diagnosis and timely management. The appropriate use of imaging tests and surgical intervention when necessary are fundamental to improving clinical outcomes and reducing associated morbidity. Understanding the underlying mechanisms and applying evidence-based guidelines are essential for the effective management of these patients.

Referencias

• [1] Acute Pancreatitis: Diagnosis and Treatment
• [2] Imaging guidelines for acute pancreatitis: when and when not to image
• [3] Management of Gallstone Pancreatitis: A Review
• [4] Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond
• [5] Practical management of severe acute pancreatitis

Created 6/1/2025