Acute biliary pancreatitis during pregnancy and post delivery period

Abstract

BACKGROUND: Acute pancreatitis has an incidence of approximately 1 in 1000 to 5000 pregnancies, and is most often seen in the third trimester or the postpartum period. The most common cause of pregnancy-related acute pancreatitis is cholelithiasis, which accounts for more than 65% of cases. The aim of this study was to present a detailed analysis of 4 years of experience with cases of acute biliary pancreatitis related to pregnancy from a single center. METHODS:The medical records of 55 consecutive patients who were hospitalized in the emergency surgery clinic for acute biliary pancreatitis related to pregnancy between January 1, 2014 and January 1, 2018 were examined in this single-center, retrospective study. RESULTS:Fifty-five patients with acute biliary pancreatitis related to pregnancy were included in the study. Of the 55 women, 13 (24%) were in the pregnant group, 28 (51%) in the postpartum (6 weeks) group, and 14 (25%) were in the 1-year (6 weeks-1 year) group. There was no statistically significant difference between the 3 groups. The most appropriate treatment for each patient was targeted. Six (10%) patients had recurrent acute pancreatitis. There was no maternal or fetal mortality or morbidity. CONCLUSION:Acute biliary pancreatitis related to pregnancy is not limited to pregnant women, and the incidence of these cases was greater than expected. Acute biliary pancreatitis related to pregnancy can be successfully managed with conservative treatment because it usually has a mild to moderate clinical course. However, the surgeon should keep an early cholecystectomy in mind for patients other than those in the first trimester.

Acute pancreatitis in pregnancy: a 10-year, multi-center, retrospective study in Beijing

“…In our cohort, most of the events (90.6%, 29/32) presented in the third trimester, which suggests an increased incidence with increasing gestational age. Gallstone is the most commonly reported etiology of AP among pregnant women in Europe and America, followed by idiopathic, alcohol abuse, and hypertriglyceridemia-induced AP [ 1 , 2 , 18 – 20 ]. However, the most common cause of APIP in Chinese women in this study was hypertriglyceridemia (56.3%, 18/32).…”

Recurrent acute pancreatitis in pregnancy

“…Progesterone causes gallbladder smooth muscle relaxation and enhances the stasis which causes gallstones formation. Gallstones migrate in the main pancreatic duct causing obstruction and activation of digestive enzymes of the pancreas leading to pancreatitis [2] . Pregnancy also increases the release of estrogen induced triglycerides due to decreased lipoprotein lipase activity [1] .…”

“…It is rare in the first and second trimester. It is most commonly (50%) seen in the third trimester followed by postpartum period [2] . The common causes of pancreatitis during pregnancy are cholelithiasis and hypertriglyceridemia.…”

Multimodality Multisystem Imaging of Pregnancy-Related Changes: Featuring Neurologic, Cardiothoracic, Breast, Gynecologic, and Musculoskeletal Issues

“…More than 65% of these cases are secondary to cholelithiasis. 40 Ultrasound is the first-line imaging modality to evaluate for cholelithiasis, peripancreatic and pancreatic edema, and dilation of the common bile duct. While the severity of necrotizing pancreatitis is assessed clinically, CT may help identify necrosis as well as define peripancreatic collections.…”