Exercise-induced cholangitis and pancreatitis

John G. Touzios, Beth Krzywda, Attila Nakeeb, Henry A. Pitt

Research output: Contribution to journalArticle

6 Scopus citations


Background. Cholangitis requires bactibilia and increased biliary pressure. Pancreatitis may be initiated by elevated intraductal pressure. The sphincter of Oddi regulates pancreatobiliary pressures and prevents reflux of duodenal contents. However, following biliary bypass or pancreatoduodenectomy, increased intra-abdominal pressure may be transmitted into the bile ducts and/or pancreas. The aim of this analysis is to document that cholangitis or pancreatitis may be exercise-induced. Methods. The records of patients with one or more episodes of cholangitis or pancreatitis precipitated by exercise and documented to have patent hepatico- or pancreatojejunostomies were reviewed. Cholangitis was defined as fever with or without abdominal pain and transiently abnormal liver tests. Pancreatitis was defined as abdominal pain, with transient elevation of serum amylase and documented by peripancreatic inflammation on computerized tomography. Results. Twelve episodes of cholangitis occurred in six patients who had undergone hepaticojejunostomy for biliary stricture (N = 3), Type I choledochal cyst (N = 2), or pancreatoduodenectomy for renal cell carcinoma metastatic to the pancreas (N = 1). Four episodes of pancreatitis occurred in two patients who had undergone pancreatoduodenectomy for ampullary carcinoma or chronic pancreatitis. Workup and subsequent follow-up for a median of 21 months have not documented anastomotic stricture. Each episode of cholangitis and pancreatitis was brought on by heavy exercise and avoidance of this level of exercise has prevented future episodes. Conclusion. Following biliary bypass or pancreatoduodenectomy, significant exercise may increase intra-abdominal pressure and cause cholangitis or pancreatitis. Awareness of this entity and behavior modification will avoid unnecessary procedures in these patients.

Original languageEnglish (US)
Pages (from-to)124-128
Number of pages5
Issue number2
StatePublished - Jan 1 2005
Externally publishedYes


  • Cholangitis
  • Exercise-induced
  • Pancreatitis
  • Postoperative

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Touzios, J. G., Krzywda, B., Nakeeb, A., & Pitt, H. A. (2005). Exercise-induced cholangitis and pancreatitis. HPB, 7(2), 124-128. https://doi.org/10.1080/136518205128882