Gallstone disease is the most common cause of acute pancreatitis and accounts for approximately 50% of cases.
Most patients with gallstone pancreatitis have mild disease and a benign clinical course with rapid recovery and response to conservative management.
Patients with severe gallstone acute pancreatitis may have significant clinical complications.
Mortality for acute pancreatitis is approximately 5% among all patients and as high as 20-30% among those with severe disease.
Patients with progressive multisystem organ failure are at highest risk for death with acute pancreatitis and mortality may be as high as 50%.
Deaths that occur within the first two weeks of acute pancreatitis are usually due to systemic inflammatory response syndrome and multisystem organ failure, whereas deaths that occur later are attributable to complications of necrotizing pancreatitis.
The pathogenesis of gallstone pancreatitis may be related to compression of the septum between the distal biliary and pancreatic ducts with secondary obstruction of the pancreatic duct, or may settle in the common channel the ampulla of Vater resulting in reflux of bile into the pancreatic duct.
The result of the above may lead to increased pressure in the pancreatic duct with pancreatic-duct obstruction and pancreatic-duct injury, with release of pancreatic enzymes into the interstitium causing pancreatic auto digestion and triggering pancreatitis.
Acute onset of pancreatic ductal obstruction appears to be important in the onset of gallstone pancreatitis.