Acute pancreatitis in pregnancy

Abstract

The spectrum of pancreatitis in pregnancy ranges from mild to severe pancreatitis. Within this spectrum there is necrotic pancreatitis, pancreatic abscess, pancreatic pseudocyst development as well as multiple organ failure. It is a low-prevalence entity. Its lithiasis origen is remarkable. The most common symptoms are abdominal pain in the epigastrium or in the right upper quadrant, nausea and hyporexia. It is often mistaken for other entities such as cholecystitis, cholangitis, and perforated peptic ulcer. It may also be associated with jaundice and respiratory distress. The diagnosis is made when levels of amylase and lipase are three times higher than its normal value. Abdominal ultrasonography is the first examination in pregnant patients. Its usefulness lies in that it detects most gallstones and does not emit radiation. Cholangiography and endoscopic retrograde cholangiopancreatography are used too (ERCP).  This treatment aims to prevent organ failure and infectious complications through the use of painkillers and antibiotics. Surgical treatment is another option which is reserved for two scenarios: in the case of complications of the disease itself like pancreatic necrosis and when trying to correct the base biliary disease (gallstone), that is to say, cholecystectomy which is in most cases performed using minimally invasive techniques (laparoscopy). The evolution in the management of pancreatitis in pregnancy has shown better results over the years. This favorable result is due to improved diagnostic and therapeutic techniques, the development of specialized human resource in charge of managing intensive care units for obstetric patients, as well as to the development of neonatal care. This article reviews three cases of pancreatitis in pregnancy and discusses their characteristics and management of these patients, taking into account the very low frequency of occurrence of this disease.