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August 1994

Hyperbilirubinemia Without Common Bile Duct Abnormalities and Hyperamylasemia Without Pancreatitis in Patients With Gallbladder Disease

Author Affiliations

From the Department of Surgery, St Louis (Mo) University School of Medicine.

Arch Surg. 1994;129(8):829-833. doi:10.1001/archsurg.1994.01420320055010

Objective:  To determine the incidence of jaundice and hyperamylasemia in the absence of common bile duct abnormalities or clinical pancreatitis in patients undergoing cholecystectomy.

Design:  A continuous, prospective analysis of a consecutive case series was performed on all patients undergoing cholecystectomy.

Setting:  An urban, tertiary care university hospital.

Patients:  Adult patients with gallbladder disease.

Intervention:  All patients underwent cholecystectomy.

Main Outcome Measures:  The presence or absence of common bile duct abnormalities was evaluated by cholangiography, and pancreatitis was identified by clinical signs, imaging studies, and direct visual inspection during cholecystectomy.

Results:  All patients (N=1746) undergoing cholecystectomy were prospectively categorized as having chronic calculous (n=1410), acute calculous (n=217), chronic acalculous (n=70), or acute acalculous (n=49) gallbladder disease. It was uncommon for patients with chronic calculous cholecystitis to have an elevated bilirubin level with no choledocholithiasis and a normal common bile duct or to have hyperamylasemia without pancreatitis. Twenty-five percent of the patients with acute calculous cholecystitis had a serum bilirubin level between 34 and 86 μmol/L (2.0 and 5.0 mg/dL) with no common bile duct abnormality and 4% had hyperamylasemia without pancreatitis. Over one third of the patients with acute acalculous cholecystitis had an elevated bilirubin level with a normal common bile duct or an elevated amylase level without pancreatitis.

Conclusion:  Jaundice and hyperamylasemia can be produced by gallbladder disease alone.(Arch Surg. 1994;129:829-833)