Gallstone Migration as a Cause of Acute Pancreatitis

Stools were screened for gallstones in 36 patients with acute pancreatitis associated with gallstones. These patients had typical clinical evidence of pancreatitis with transiently elevated serum amylase and bilirubin concentrations. Another 36 patients with gallstones but without acute pancreatitis served as controls. Gallstones were found in the feces of 34 out of 36 patients with pancreatitis, but in only three out of the 36 control cases. In the former group, the finding was usually preceded by a relief of the symptoms and a rapid decrease of serum amylase and bilirubin concentrations. The calculi found in the stools and those found in the biliary tracts of the patients at operation were identical as determined by gross inspection and chemical analysis. These findings suggest that acute pancreatitis associated with gallstone disease is frequently caused by transient blockage of the ampulla of Vater by migrating gallstones. (N Engl J Med 290:484–487, 1974)