Gallstone pancreatitis.

Gallstone pancreatitis is a disease of high mortality (11%) and significant morbidity (42%). An analysis of 66 patients with this disease revealed the importance of an early aetiological diagnosis; 66% of our patients had evidence of previous biliary disease. Most patients were elderly and the severity of their disease could be predicted using Ranson's predictive indices. Surgery was immediate (within 48 hours) in 11 (17%) patients, early (two-14 days) in 16 (24%) and delayed in 27 (41%) patients. Some patients refused surgery. Our study suggests that very ill patients require immediate surgery--often cholecystostomy alone--and that although in the majority symptoms should settle on conservative treatment, definitive surgery should be carried out at the time of the initial admission. Further delay increases morbidity, mortality and expense.