• Anthony Lin, Peter Stiven, Philip Bagshaw, and Saxon Connor.
• Christchurch School of Medicine and Health Sciences, University of Otago.
• N. Z. Med. J. 2006 Jan 1;119(1239):U2104.

AimsTo review the management and outcome of patients presenting with acute biliary pain/cholecystitis, mild acute pancreatitis, or cholangitis to a major New Zealand (NZ) metropolitan hospital.MethodsA retrospective case note review was performed for all patients admitted acutely to Christchurch Public Hospital between 1 February 2005 and 31 September 2005, with the diagnosis of acute biliary pain/acute cholecystitis, acute pancreatitis, or cholangitis. Basic demographics, inpatient management, and subsequent outcome were recorded.ResultsSixty-eight (65%) patients were admitted with acute biliary pain/cholecystitis, 23 (22%) with mild acute pancreatitis, and 13 (13%) with cholangitis. Twelve of 81 (15%) patients (who were suitable for index cholecystectomy) underwent surgery, including only 3 of the 18 patients with mild acute pancreatitis. In the remaining 69 (85%) patients, who were eligible but did not undergo cholecystectomy at the index admission, 29 (42%) subsequently represented to the emergency department. Forty-eight (70%) patients required further inpatient admission related to gallstone-related pathology within the study period. Subsequently, 42 (61%) of the 69 patients treated conservatively underwent cholecystectomy at a median (range) of 70 (1-195) days from index admission, including 6 emergency cholecystectomies due to re-presentationConclusionsThe management of acute gallstone-related disease at a major NZ metropolitan hospital fails to meet with current international standards. Few patients undergo index cholecystectomy, and a large proportion of those treated conservatively return to the health sector with ongoing problems.

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