Acute gallstone pancreatitis with pseudocyst as a complication.

Gallstone disease as the etiology of pancreatitis is much more common in private hospital patients than was once described. Common duct stones (choledocholithiasis) have been proven not to coexist in the majority of cases. The objectives of surgery for gallstone pancreatitis therefore should be adequate drainage of the pancreas, evaluation of the common duct, and cholecystectomy. Common duct exploration usually is not warranted or advised.A pseudocyst may occur subsequent to the acute phase of pancreatitis, or subsequent to surgery for pancreatitis if the pancreas is not adequately and widely drained. The collection of fluid adjacent to or within the pancreas must be determined to be either a pancreatic abscess or a pancreatic pseudocyst. The management of the pseudocyst, which is usually diagnosed by the ultrasonographic finding of a thickened wall, is adjacent internal drainage. By contrast, the pancreatic abscess must have wide, radical, external drainage.Mature judgement must be exercised in the approach to, the timing of, and the management of surgery for gallstone pancreatitis or pseudocyst formation.