We report a case of a 52-year-old man admitted to our hospital because of acute biliary pancreatitis caused by cholelithiasis. The patient also had choledocholithiasis complicated with pancreatic pseudocyst. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and a large number of common bile duct stones were extracted with Dormia basket upon papillotomy. Pancreatic pseudocyst as a major complication of acute pancreatitis was also managed endoscopically by transpapillary stenting. Laparoscopic cholecystectomy with choledochotomy and choledochoscopy was performed for the final removal of biliary stones. Postoperative subhepatic abscess was resolved by ultrasound-guided percutaneous drainage. In this case biliary pancreatitis with all its complications was treated through minimally invasive endoscopic, percutaneous and surgical procedures. Minimally invasive techniques are much better because they reduce surgical stress, caused by reduction of flow through the splanchnic, which can also be reinforced by general endotracheal anesthesia. In the case when relative hypoxia occurs and acute serous pancreatitis transfers to acute necrotic pancreatitis, minimally invasive technique is the first and the best choice for surgical procedure.
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