Acute pancreatitis related to grossly minute stones in a radiographically normal gallbladder

Summary and conclusions

1. The unusual association of a few grossly minute gallstones, not detected by usual radiographic technics, with recurrent acute pancreatitis is recorded for 6 patients.

2. Acute pancreatitis does not recur if biliary tract lithiasis is eradicated in these patients. In addition to cholecystectomy, exploration of the common bile duct of these patients usually is required.

3. The finding of microspheroliths, cholesterol crystals, and calcium bilirubinate pigment by diagnostic biliary drainage provides support in deciding for biliary tract surgery for these patients.

4. Biliary tract surgery including cholecystectomy is justified for patients suffering from recurrent acute pancreatitis, in whom abnormal inclusions are found in diagnostic biliary drainage, and in whom alcoholism and other causes of pancreatitis are absent. Cholecystectomy should be done even though the gallbladder appears normal on repeated cholecystograms, and is normal to palpation at the time of operation.