Pancreatitis, pregnancy and gallstones
In an 18 year hospital experience of over 500 patients with primary acute pancreatitis, 20 developed the disease either while pregnant (7 patients) or within five months of pregnancy (13 patients). Eighteen of the 20 patients had gallstones and adequate biliary surgery abolished further attacks of pancreatitis. Only two patients had surgery during the acute phase of their illness. The single fetal death was associated with early surgical intervention and there were no maternal deaths. We found no evidence of a specific link between pregnancy and pancreatitis but there is a marked association between pancreatitis and gallstones.
Available from: ncbi.nlm.nih.gov
- "Severe acute pancreatitis (SAP) in pregnancy usually occurs in the third trimester, and the severely affected patients are more liable to develop a critical condition that results in a higher risk of intrauterine fetal death . But McKay et al. found that there was no evidence of a specific link between pregnancy and pancreatitis, but there was a marked association between pancreatitis and gallstones . Pregnancy-related hypertriglyceridemia is rare, but it can be life threatening in some patients with genetic susceptibility. "
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ABSTRACT: Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP) in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1) Nine cases of 22 mild acute pancreatitis (MAP) patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients' requirements. (2) Four cases of all patients were complicated with severe acute pancreatitis (SAP); 2 cases underwent uterine incision delivery while one of them also received cholecystectomy, debridement and drainage of pancreatic necrosis, and percutaneous jejunostomy. One case had a fetal death when complicated with SAP; she had to receive extraction of bile duct stones and drainage of abdominal cavity after induced abortion. The other one case with hyperlipidemic pancreatitis was given induced abortion and hemofiltration. Conclusions. The first choice of MAP in pregnancy is the conventional therapy. Apart from the conventional therapy, we need to terminate pregnancy as early as possible for patients with SAP. Removing biliary calculi and drainage is supposed to be considered for acute biliary pancreatitis. Lowering blood lipids treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration when necessary.
Available from: Adolfo L. Trochez
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ABSTRACT: Presentamos un caso ilustrativo de una paciente de 18 años de edad, previamente sana, primigestante, con embarazo a término y cuadro de patología abdominal, compatible con pancreatitis aguda severa, documentada mediante la clínica y ayudas diagnosticas como amilasuria y TAC abdominal. Presenta como complicación óbito fetal. Dada de alta 10 días después en mejores condiciones generales. La pancreatitis aguda durante el embarazo es una grave y rara complicación. Se destaca la importancia del diagnóstico correcto y las opciones terapéuticas en pacientes embarazadas para asegurar el bienestar materno y fetal Palabras clave: Pancreatitis aguda, embarazo ABSTRACT We present an illustrative case of a patient of 18 years old, previously healthy, term pregnancy and abdominal pathology, consistent with severe acute pancreatitits, documented by clinical and diagnostic aids as amilasa in urine and abdominal CT scan. Introducing complication fetal death. Given high 10 days later in better conditions. Acute pancreatitis during pregnancy is a serious and rare complication. It stresses the importance of proper diagnosis and treatment options in pregnant patients to ensure the welfare maternal and fetal
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