Acute gallstone pancreatitis accounts for 60% of the causes of acute pancreatitis and is a common cause of acute abdominal pain. Its pathogenesis, clinical manifestations, and diagnostic approach are consistent with the description provided in Acute Pancreatitis.
The treatment approach is primarily dependent on whether biliary obstruction is present. For patients with biliary obstruction, ERCP is the first-line therapy to relieve the obstruction. In patients with impacted common bile duct stones accompanied by acute cholangitis, ERCP is recommended within 24 hours. For those with impacted common bile duct stones without clear evidence of cholangitis, ERCP is recommended within 72 hours.
In cases without biliary obstruction, non-surgical management is preferred initially. For patients with coexisting gallstones, early cholecystectomy is advised. For mild cases, surgical intervention is recommended prior to discharge after confirming the absence of common bile duct stones. In patients with moderate to severe disease, ERCP is carried out first, and surgery is planned once peripancreatic exudates and fluid collections stabilize, typically within 1 to 3 months after recovery.