ACUTE pancreatitis is usually distinguished from chronic pancreatitis by assessing whether the pancreas was normal in structure or function before the onset of the disease.¹ In the United States, chronic pancreatitis is most often associated with chronic alcohol abuse, whereas acute pancreatitis is usually associated with biliary tract stones. A number of studies, most notably that by Acosta and Ledesma,² have shown that attacks of "gallstone pancreatitis" occur when the stones become impacted in the terminal common bile duct or pass through the sphincter of Oddi into the duodenum.

How stones that pass through or become lodged in the terminal . . .