Abstract
Introduction
Acute pancreatitis during pregnancy is a severe disease with a high materno–fetal mortality, which recently decreased because of earlier diagnosis and improvement in maternal and neonatal intensive care.
Case
We describe a 19-year-old woman who presented at 37 weeks gestation with acute abdominal pain and attacks of vomiting. Obstetrical and fetal examinations were normal. Biochemical investigations and magnetic resonance imaging showed a gallstone migration with necrotizing pancreatitis (Balthazar 5 points). Our multidisciplinary team decided on nonsurgical conservative treatment including morphine administration and enteral feeding, and vaginal delivery which was possible 30 h after induction of labor. Follow up was uneventful with a resolution of pain and signs of pancreatitis on imaging.
Conclusion
Magnetic resonance imaging can be useful and safe to estimate the severity of acute and necrotizing pancreatitis in the third trimester of pregnancy. In case of sterile necrotizing pancreatitis, nonsurgical conservative treatment and a vaginal delivery should be performed when possible in these patients to reduce the risk of maternal infection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Augustin G, Majerovic M (2007) Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 131:4–12. doi:10.1016/j.ejogrb.2006.07.052
Hernandez A, Petrov MS, Brooks DC et al (2007) Acute pancreatitis and pregnancy: a 10-year single center experience. J Gastrointest Surg 11:1623–1627. doi:10.1007/s11605-007-0329-2
Wilkinson EJ (1973) Acute pancreatitis in pregnancy: a review of 98 cases and a report of 8 new cases. Obstet Gynecol Surv 28:281–303. doi:10.1097/00006254-197305000-00001
Ramin KD, Ramin SM, Richey SD et al (1995) Acute pancreatitis in pregnancy. Am J Obstet Gynecol 173:187–191. doi:10.1016/0002-9378(95)90188-4
Robertson KW, Stewart IS, Imrie CW (2006) Severe acute pancreatitis and pregnancy. Pancreatology 6:309–315. doi:10.1159/000092694
Ranson JH (1982) Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol 77:633–638
Uhl W, Warshaw A, Imrie C et al (2002) IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2:565–573. doi:10.1159/000071269
Nealon WH, Bawduniak J, Walser EM (2004) Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections. Ann Surg 239:741–749. doi:10.1097/01.sla.0000128688.97556.94
Bai Y, Gao J, Zou DW, Li ZS (2008) Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials. Am J Gastroenterol 103:104–110
McClave SA (2007) Nutrition support in acute pancreatitis. Gastroenterol Clin North Am 36:65–74. doi:10.1016/j.gtc.2007.01.002
Arvanitakis M, Koustiani G, Gantzarou A et al (2007) Staging of severity and prognosis of acute pancreatitis by computed tomography and magnetic resonance imaging-a comparative study. Dig Liver Dis 39:473–482. doi:10.1016/j.dld.2007.01.015
Webb JA, Thomsen HS, Morcos SK et al (2005) The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 15:1234–1240. doi:10.1007/s00330-004-2583-y
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ducarme, G., Châtel, P., Alves, A. et al. Management of necrotizing pancreatitis in the third trimester of pregnancy. Arch Gynecol Obstet 279, 561–563 (2009). https://doi.org/10.1007/s00404-008-0759-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-008-0759-4