The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis

Abstract

Screening stools for gallstones in patients with acute pancreatitis has been found to be a valuable diagnostic procedure in clinical practice. It is particularly helpful to know that a patient with pancreatitis has gallstones and, therefore, the disease is probably caused by the passage of these stones. A detailed description of the technique employed for stool screening is presented. The procedure was applied in 51 patients recovering from an attack of gallstone pancreatitis, in 51 control patients with known gallstones disease but without acute pancreatitis, and also in 10 patients with acute alcoholic pancreatitis. Gallstones were found in the feces in 47 of the 51 patients with gallstone pancreatitis (92.1%), in only 6 of the 51 control cases (11.8%) (chi square = 62.84;P<0.0001), and in none of the 10 patients with alcoholic pancreatitis. In the group with gallstone pancreatitis, the finding occurred within 10 days after the attack. Oral cholecystography was also accomplished an average of 12.7 days after the attack in 38 of the 61 pancreatitis patients (28 with biliary and 10 with alcoholic pancreatitis). In 27 of the 28 patients with gallstone pancreatitis (96.4%) and in 4 of the 10 patients with alcoholic pancreatitis, radiologic evidence of cholelithiasis was found. There were 19 patients with gallstone pancreatitis who did not have a cholecystogram accomplished because of jaundice, recurrent pancreatitis, previous cholecystectomy, and pregnancy. These results suggest that screening stools is as accurate and reliable as cholecystography for the diagnosis of gallstones in individuals with pancreatitis. In addition, this method has three definite advantages over cholecystography: There are no contraindications; it requires no special equipment or personnel; and it can be used much earlier than cholecystography in patients recovering from an attack of acute pancreatitis. Screening stools for gallstones should be considered an elective diagnostic procedure for current clinical application.