Acute pancreatitis is the sudden (not chronic) inflammation of the pancreas. The pancreas is situated deep in the abdomen. It lies behind the stomach and the large intestine, and is in close contact with major vessels. As its position indicates, its inflammation may affect the function of almost all organs in the abdomen. Acute pancreatitis is rather devious; it occurs suddenly and has no warning signs that could allow for a timely diagnosis. Preventing its progression is not easy. Often, patients are referred to general physicians or pathologists instead of highly specialized pancreatic surgeons. This is a common mistake as general physicians may not be familiar with current treatment methods that are very different from the methods employed 10 or even 5 years ago. Treatment methods are rapidly advancing with each passing day.

Cholelithiasis is, in most cases, the leading cause of acute pancreatitis. Cholelithiasis refers to the presence of pebble-like pieces of bile formed in a patient’s gallbladder. The bile empties from the gallbladder to the bile duct (small tube), which empties to the duodenum (the first part of the small intestine after the stomach). The bile duct passes through the pancreas before it empties into the duodenum.

As the gallbladder contracts and empties, the pebble-like pieces, stones, or sludge contained, may flow into the bile duct, get stuck in the lower part of the bile duct, and block the pancreas. This blockage may cause pancreatitis. Pancreatitis is more likely to occur when gallstones are small or when there’s sludge because this is the only way gallstones or sludge can pass through and get stuck into the bile duct. On the other hand, gallbladder stones (also known as “gallstones”) that are larger, do not fit into the bile duct and cannot cause pancreatitis. This detail is very important. Patients tend to feel reassured once doctors tell them that the stones are small or that there’s only sludge, even though they should actually feel reassured when the stones are larger.

The severity of an acute pancreatitis episode determines the treatment that shall be followed. In very severe cases, which are, thankfully, not common, patients must be admitted to an ICU as there’s not only inflammation of the pancreas but also necrosis. This is an extremely serious case that is associated with very high mortality rates (up to 40%). Usually, patients are hospitalized until acute pancreatitis is completely treated. Then, they undergo laparoscopic cholecystectomy that eliminates the root cause of the problem. Before moving forward with laparoscopic cholecystectomy, doctors must be completely certain that the stone blocking the bile duct is no longer present. A Magnetic Resonance Cholangiopancreatography may need to be performed at this stage.