Combined laparoscopic cholecystectomy with ileostomy reversal: A method of delayed definitive management of postoperative gallstone pancreatitis
A 44-year-old male with a history of sigmoid colectomy for endoscopically unresectable adenoma presented to us with rectal bleeding. Colonoscopy revealed recurrent sessile mass at the colorectal anastomosis. Biopsy revealed villous adenoma with high grade dysplasia. He underwent re-do low anterior resection with diverting loop ileostomy. He had an uneventful recovery and was discharged on POD 10. However, 4 days later he presented with epigastric and RUQ abdominal pain. The patient's clinical examination revealed mild epigastric tenderness. Laboratory studies revealed a WBC count of 13,000, lipase and amylase above 400, and normal bilirubin. Ultrasonography revealed gallstones (GS). GP was diagnosed and then managed non-operatively, similar to our first case. He refused ERCP/S. After discharging, the patient returned in 6 weeks for ileostomy reversal and cholecystectomy as described below.