Acute pancreatitis and severe hyperbilirubinemia as initial presentation of Gilbert syndrome

Gilbert syndrome (GS) is benign, often familial condition characterized by recurrent but asymptomatic mild unconjugated hyperbilirubinemia in the absence of hemolysis or underlying liver disease. The coexistence of GS with other more clinically significant conditions could interfere with their diagnoses. The genetic variation described as GS may affect drug glucuronidation and could potentially precipitate. Gallstones are the commonest ailment affecting the hepato-biliary system. Associated jaundice is usually direct, commonly due to biliary obstructive lesions. Unconjugated hyperbilirubinemia with cholelithiasis is commonly seen with hemolytic disease. In the absence of hemolysis or systemic causes, congenital causes prevail, commonest of which is Gilbert’ Syndrome. Here we report a case of 21-year old male who presented to our hospital with complaint of pain abdomen and was diagnosed as gall stone induced pancreatitis which was further diagnosed as GS after genetic testing for UGT1A1 gene polymorphism.