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Acute pancreatitis during pregnancy – A case report

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ABSTRACT
Introduction. Studies report different incidence of acute pancreatitis (AP) during pregnancy, with a frequency rate between 1/1000 – 1/10 000 pregnancies.
Case report. We present the case of a 26-year-old primipara, 35 weeks pregnant woman, who came to our hospital through transfer from a municipal hospital with the diagnosis of acute pancreatitis (AP). On admission she presented nausea, vomiting, epigastric pain and impaired general state, symptoms that started 3 days before and rapidly worsened. In the context of acute pancreatitis and uncertain fetal status, keeping in mind the possible negative outcome as a consequence of fetal and maternal complications in acute pancreatitis, we decided that the patient should undergo immediate caesarean section.
Conclusions. There are no specific and well documented management protocols for acute pancreatitis in pregnancy.
Key words: acute pancreatitis, pregnancy, gallstones.

INTRODUCTION
Studies report different incidence of acute pancreatitis (AP) during pregnancy, with a frequency rate between 1/1000 – 1/10 000 pregnancies1. It is frequent in the 3rd trimester (50%) and in postpartum (38%), with higher frequency in multiparous women2. Acute pancreatitis in pregnancy is usually caused by gallstones – with frequencies that vary between 65% to 100%3,4. Studies show that other, rather common causes of pancreatitis outside pregnancy are less common in pregnant women – alcohol abuse, idiopathic causes or familial triglyceridemia. While older studies report high mortality rates, both maternal and fetal, with large variations, between 20% and 60%5,6, more recent studies report far lower rates (0%-4.7%)3,7, mostly due to the modern diagnostic techniques and the modern treatment of gallstones.

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