Management of Gallstone-Induced Acute Pancreatitis in Pregnancy: A Tertiary-Center Experience

Objectives: Gallbladder stones are the most frequently reported etiology of acute pancreatitis in pregnancy and are often diagnosed in the third trimester. This condition is associated with both mother and infant morbidity and mortality, and its treatment remains controversial.
Methods: Relevant patient data between September 2010 and April 2017 from the Kanuni Sultan Suleyman Training and Research Hospital were analyzed regarding etiology (of gallstone pancreatitis), trimester of pregnancy, diagnostic tools, pancreatitis stage, clinical status, medical treatment, surgical interventions, and pregnancy status.
Results: We included 68 patients recorded with acute pancreatitis due to biliary gallstones. Pancreatitis symptoms developed in most (n=38) (55.8%) patients during the third trimester. Of 24 patients who had their first episode of pancreatitis in the first trimester of pregnancy, 12 (50%) were readmitted due to recurrence. Seven (11.3%) patients whose Ranson scale score was 3 underwent computed tomography evaluation. The number of patients with acute cholecystitis with pancreatitis was 5 (7.3%), whereas the number of patients with choledocholithiasis was 4 (5.8%). Sphincterotomy with endoscopic retrograde cholangiopancreatography was performed in 2 (2.9%) patients. Laparoscopic cholecystectomy was performed in 9 (13.2%) patients during pregnancy. No fetal and maternal morbidity and mortality was found in all periods.
Conclusion: Developments in supportive care, wide-spread use of imaging methods, and a multidisciplinary approach with better antenatal care of pregnant patients with acute pancreatitis can help prevent fetal and maternal morbidity and mortality in such cases. Early laparoscopic cholecystectomy should be considered especially in pregnant patients with acute pancreatitis due to gallstones in the first trimester.

Gebelikte safra taþý nedenli akut pankreatit yönetimi: Üçüncü basamak merkez deneyimi

Amaç: Gebelik döneminde akut pankreatit etyolojisi en sýk safra kesesi taþlarýna baðlý olmaktadýr ve hastalýk sýklýkla gebeliðin üçüncü trimesterinde görülmektedir. Gebelikte pankreatit hem anne hem de fetüs için morbidite ve mortaliteyi arttýrmakla birlikte teþhis ve tedavi günümüzde halen tartýþmalýdýr.
Yöntemler: Eylül 2010-Nisan 2017 tarihleri arasýnda kanuni sultan süleyman eðitim ve araþtýrma hastanesi’nde, safra kesesi taþlarýna baðlý pankreatit geçiren gebe hastalarýn teþhis anýndaki trimestr dönemleri, taný yöntemleri, pankreatitin þiddeti, klinik takipleri, giriþimsel iþlem ve cerrahi sonuçlarý ve hamilelik durumu dahil olmak üzere retrospektif olarak analiz edildi.
Bulgular: 68 gebe hasta da safra taþlarýna baðlý pankreatit saptandý. Ýlk pankreatit semptomlarý çoðunlukla (n=38) (%55.8) üçüncü trimestr da tespit edildi. Gebeliðin ilk trimestrinde ilk ataðý saptanan hastalarýn 12 ‘sinde (%50) gebelik dönemi içerisinde rekürren pankreatit tespit edildi. Orta derecede pankreatit tespit edilen ve Ranson 3 olan 7 (%11.3) hastada BT deðerlendirmesi de yapýldý. 5 (%7.3) hastada pankreatitle birlikte akut kolesistit teþhisi, 4 (%5.8) hastada da koledokolitiazis teþhisi de konuldu. ERCP ile sfinkterotomi 2 (%2.9) olguda yapýldý. 9 (%13.2) hastada gebelik sýrasýnda
laparoskopik kolesistektomi yapýldý. Fetal ve maternal morbidite ve mortalite görülmedi.
Sonuç: Multidisipliner yaklaþým, görüntüleme yöntemlerinin etkin kullanýmý ve gebelik dönemindeki takiplerin düzenli yapýlmasý akut pankreatit teþhisinde hem fetal ve hem de maternal mobidite ve mortaliteyi ciddi oranda azaltýr. Özellikle birinci trimesterdeki safra taþý nedeniyle akut pankreatit teþhisi konulan hastalarda rekürren pankreatit geliþimini engelemek için erken dönemde laparoskopik kolesistektomi önerilebilir.