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Article |

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

Steve M. Kurzweil, MD; Marc J. Shapiro, MD; Charles H. Andrus, MD; Catherine M. Wittgen, MD; Virginia M. Herrmann, MD; Donald L. Kaminski, MD
Arch Surg. 1994;129(8):829-833. doi:10.1001/archsurg.1994.01420320055010.
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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)


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