The tales of two neighbours: when cholecystitis does not preclude pancreatitis

Abstract

An 83-year-old lady with no previous history of gallstones, presented with a sudden-onset severe epigastric pain radiating through to the back associated with nausea and vomiting. On examination, the patient's vital signs were normal. There was severe epigastric tenderness on palpation, as well as moderate right upper quadrant tenderness. Serological investigations showed raised inflammatory markers and serum lipase of 13 000, confirming the diagnosis of acute pancreatitis. Liver function tests were mildly deranged with a normal bilirubin of 12 μmol/L. An abdominal ultrasound demonstrated a distended gallbladder with multiple subcentimeter gallstones and diffuse wall thickening up to 7 mm, consistent with cholecystitis. A follow-up CT abdomen demonstrated evidence of pancreatitis with moderate peripancreatic fat stranding. The diagnosis of concomitant acute cholecystitis and gallstone pancreatitis was made based on the radiological and biochemical findings. The patient underwent an uncomplicated laparoscopic cholecystectomy. The histopathology confirmed cholelithiasis with acute on chronic cholecystitis.

Figure 1:

Ultrasound image of cholecystitis demonstrating thickened gallbladder wall.

Figure 2:

CT image of pancreatitis with peripancreatic fat stranding.