Managing Idiopathic Pancreatitis

The term “idiopathic pancreatitis” has long been defined as pancreatitis when the etiology cannot be explained by thorough history, physical examination, laboratory studies, and imaging including transabdominal ultrasound and computed tomography (CT). The diagnosis should be one of exclusion and should account for no more than 20% of cases. The vast majority of patients with idiopathic pancreatitis are due to undiagnosed stones or microlithiasis and therefore thorough investigation with high quality ultrasound, endoscopic ultrasound and other specific investigations should be undertaken prior to determination of idiopathic pancreatitis. Diagnoses to exclude include hereditary pancreatitis, autoimmune pancreatitis, Spincter of Oddi dysfunction and pancreas divisum. In patients in whom microlithiasis is the etiology, laparoscopic cholecystectomy should be undertaken.