Combined laparoscopic cholecystectomy with ileostomy reversal: A method of delayed definitive management of postoperative gallstone pancreatitis
A 31-year-old male with adenomatous polyposis coli gene mutation and familial adenomatous polyposis presented prophylactic surgical treatment. His preoperative endoscopic evaluation revealed no duodenal or ampullary pathology. He underwent an uncomplicated laparoscopic total proctocolectomy with ileal j-pouch anal anastomosis and diverting loop ileostomy. On postoperative day (POD) 8, he developed acute epigastric and right upper quadrant (RUQ) pain. His vital signs were normal and clinical exam was unrevealing. Laboratory studies revealed a white blood cell (WBC) count of 14,000, serum lipase and amylase of 1300, and normal bilirubin. Ultrasonography revealed gallbladder sludge. A diagnosis of GP was made. He was placed on bowel rest with IV hydration until pancreatitis improved clinically and biochemically. Cholecystectomy was deferred until planned ileostomy reversal. To decrease the risk of recurrent episodes of GP, endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP/S) was performed. He was discharged on POD 17. The patient then underwent ileostomy reversal and cholecystectomy as described below 6 weeks later.