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The significance of gallbladder sludge in the patient with acute pancreatitis
Critical Care volume 11, Article number: P403 (2007)
The significance of gallbladder sludge as a potential cause of acute biliary pancreatitis is debated. We report the incidence and outcome of patients with gallbladder sludge in a large population of patients with pancreatitis.
Pancreatitis was defined as constant epigastric pain with lipase greater than three times the upper reference value for our laboratory (177 U/l). Consecutive patients with first episodes of acute pancreatitis were identified over a 2-year period and data were evaluated retrospectively. Patients were followed prospectively for 2 years more.
All patients had gallbladder ultrasound examinations. First episodes of acute pancreatitis were identified in 356 patients. Initially 236 patients had stones directly visualized in the gallbladder. Of the remaining 120 patients, 13 had sludge, 11 had a dilated common bile duct, one had a positive sonographic Murphy sign, and 95 had no abnormalities. During the time course of the study, 23 of these 120 patients were demonstrated to have stones; by the surgical pathology report (12), endoscopic retrograde cholangio-pancreatography (10), and cholecystostomy (one). Seven of 13 patients with sludge underwent cholestectomy and all had evidence of stones. Four of six nonoperated patients with sludge (67%) returned with recurrent pancreatitis over the course of the study. Ten of 97 patients (10%) with suspected nonbiliary etiology of the pancreatitis returned with recurrent pancreatitis over the same period. The nonoperated patients with sludge were more likely to have other risk factors for nonbiliary pancreatitis than were the operated patients.
The presence of sludge on the gallbladder ultrasound suggests the presence of stones and is associated with a high rate of recurrence of pancreatitis in nonoperated patients.
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Delaney, K., Velez, L. The significance of gallbladder sludge in the patient with acute pancreatitis. Crit Care 11, P403 (2007). https://doi.org/10.1186/cc5563
- Bile Duct
- Acute Pancreatitis
- Common Bile Duct