Answer for CoW 30 October 2016
GALL STONE PANCREATITIS
Findings
Few tiny gall bladder calculi with sludge and mild gall bladder wall thickening – suggestive of Calculous cholecystitis. Relatively bulky pancreas with restricted diffusion low ADC values – suggestive of acute pancreatitis MRCP revealed normal Biliary and Pancreatic Ducts .
Discussion
This patient had significantly elevated Serum Amylase levels of 1040 and the Diagnosis of Gall Stone Pancreatitis was made based on the Findings of Restricted Diffusion of Pancreas and elevated Amylase levels . Gallstone pancreatitis is due to ampullary obstruction by common bile duct (CBD) calculi. However MRCP has poor sensitivity of 62% and high specificity of 98% to pick up distal CBD calculi. 1.Selective MRCP is highly specific in gallstone pancreatitis but may not be sensitive enough to exclude choledocholithiasis in this context. 2. small stones can be missed even during therapeutic ERCP. Therefore, EUS has recently been proposed as the new gold standard in the diagnosis of choledocholithiasis Ref: 1.Can J Surg. 2010 Dec;53(6):403-7. Selective use of magnetic resonance cholangiopancreatography in clinical practice may miss choledocholithiasis in gallstone pancreatitis 2.Role and timing of endoscopy in acute biliary pancreatitisWorld J Gastroenterol. 2015 Oct 28; 21(40): 11205–11208
Findings
Few tiny gall bladder calculi with sludge and mild gall bladder wall thickening – suggestive of Calculous cholecystitis. Relatively bulky pancreas with restricted diffusion low ADC values – suggestive of acute pancreatitis MRCP revealed normal Biliary and Pancreatic Ducts .
Discussion
This patient had significantly elevated Serum Amylase levels of 1040 and the Diagnosis of Gall Stone Pancreatitis was made based on the Findings of Restricted Diffusion of Pancreas and elevated Amylase levels . Gallstone pancreatitis is due to ampullary obstruction by common bile duct (CBD) calculi. However MRCP has poor sensitivity of 62% and high specificity of 98% to pick up distal CBD calculi. 1.Selective MRCP is highly specific in gallstone pancreatitis but may not be sensitive enough to exclude choledocholithiasis in this context. 2. small stones can be missed even during therapeutic ERCP. Therefore, EUS has recently been proposed as the new gold standard in the diagnosis of choledocholithiasis Ref: 1.Can J Surg. 2010 Dec;53(6):403-7. Selective use of magnetic resonance cholangiopancreatography in clinical practice may miss choledocholithiasis in gallstone pancreatitis 2.Role and timing of endoscopy in acute biliary pancreatitisWorld J Gastroenterol. 2015 Oct 28; 21(40): 11205–11208
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!