Gallstone pancreatitis

Last revised by Jeremy Jones on 20 Sep 2021

Gallstone pancreatitis refers to pancreatitis caused by gallstones, specifically distal choledocholithiasis. Gallstones are the cause for 35-40% of acute pancreatitis but this number has a wide regional variance. 

Gallstone pancreatitis has a higher incidence in women (compared to alcohol-induced pancreatitis, which has a higher incidence in men) 4

The exact pathophysiology of gallstone pancreatitis remains unclear. There are a number of theories 2,3:

  • distal gallstone obstruction results in pancreatic duct obstruction, this results in increased pancreatic duct pressure and unregulated pancreatic enzyme activity
  • acinar cell hyperstimulation has also been implicated
  • infected bile reflux inducing pancreatic enzyme action

Treatment options vary but include:

  • conservative management
  • cholecystectomy
    • may be performed acutely during the index admission, or after a short interval after discharge
    • If gallstones are not treated, recurrence occurs in ~45% (range 32-61%) 4
  • ERCP
    • Meta-analysis show no benefit of routine ERCP in gallstone pancreatitis in the absence of biliary obstruction or cholangitis 5

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Cases and figures

  • Case 1: MRCP
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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