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Archives of Gynecology and Obstetrics

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01-04-2009 | Case Report

Management of necrotizing pancreatitis in the third trimester of pregnancy

Authors: Guillaume Ducarme, Paul Châtel, Arnaud Alves, Pascal Hammel, Dominique Luton

Published in: Archives of Gynecology and Obstetrics | Issue 4/2009

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.

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

Robertson KW, Stewart IS, Imrie CW (2006) Severe acute pancreatitis and pregnancy. Pancreatology 6:309–315. doi:10.1159/000092694 PubMedCrossRef

Ranson JH (1982) Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol 77:633–638PubMed

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 PubMedCrossRef

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 PubMedCrossRef

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 103:104–110PubMed

10.

McClave SA (2007) Nutrition support in acute pancreatitis. Gastroenterol Clin North Am 36:65–74. doi:10.1016/j.gtc.2007.01.002 PubMedCrossRef

11.

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 PubMedCrossRef

12.

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 PubMedCrossRef

Title: Management of necrotizing pancreatitis in the third trimester of pregnancy
Authors: Guillaume Ducarme
Paul Châtel
Arnaud Alves
Pascal Hammel
Dominique Luton
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 4/2009
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-008-0759-4

At a glance: The STEP trials

Springer Medicine

Management of necrotizing pancreatitis in the third trimester of pregnancy

Abstract

Introduction

Case

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Case

Conclusion

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