Acute Pancreatitis and Pregnancy

Authors : Bensal Abdelhak; Belhamidi Said; Moutaoukil Mohamed; Bouchentouf Sidi Mohamed; Moujahid Mountacer; Bounaim Ahmed

Volume/Issue : Volume 5 - 2020, Issue 8 - August

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DOI : 10.38124/IJISRT20AUG536

Acute pancreatitis is a rare condition during pregnancy. Gallstones are the most common etiology.Its diagnosis should not suffer from delay because its evolution can jeopardize the vital maternal and fetal prognosis.We report the observation of woman, 27 years old, pregnant at 27 weeks of amenorrhea. She was admitted for epigastric pain evolving for four days, her lipasemia was at 360 IU / L. Abdominopelvic ultrasound showed a thin-walled lithiasic gallbladder, the non-dilated intra and extra hepatic bile ducts and an enlarged pancreas; Active pregnancy with presence of fetal heart activity. MRI performed immediately objectified a multilithiasic gallbladder with moderate dilation of the common bile duct, which is the site of 3 non-obstructive microlithiasis, the pancreas is enlarged. The patient was put on rest with a diet low in lipids, good rehydration (basic ration with electrolyte supplementation, symptomatic treatment. satisfactory check-up and she left after five days of hospitalization with a check-up and possible cholecystectomy after childbirth. Acute pancreatitis rarely occurs during pregnancy; the reported frequency ranges from 1 in 1000 to 3 in 10000 births. The most common etiology is cholelithiasis in 70% of cases. According to Pitchumoni, more than 50% of acute pancreatitis occurs, as in our patient, in the 3rd trimester. The clinical symptomatology and a high lipasemia allow us to make the diagnosis of acute pancreatitis. The abdominal ultrasound confirms the biliary etiology, however she does not appreciate the pancreas. The abdominal scanner cannot be performed due to the risk of irradiation, we performed a biliMRI whose sensitivity is 90% without risk either for the mother or for the fetus. The management of acute benign pancreatitis is done in collaboration with gynecologists and is based on the diet to put to rest the endocrine function of the pancreas and symptomatic treatment with a good prognosis. In severe forms or associated with cholangitis management is multidisciplinary with a prognosis reserved for the mother. A delay in diagnosis and treatment worsens the prognosis. The medical treatment is identical to acute pancreatitis outside of pregnancy, however there remains the specific treatment of acute pancreatitis secondary to cholelithiasis, because on the one hand we must consider the high rate of recurrences during pregnancy estimated at 70 %, and on the other hand consider both the maternal risk which depends on the anatomical type of acute pancreatitis and the gestational age of onset, and the fetal risk which depends on the severity of the clinical form.

Keywords : Acute Pancreatitis, Pregnancy and abdominal pain.


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