Pancreatitis y embarazo

Pancreatitis biliar aguda relacionada al embarazo: experiencia de 5 años de un centro Acute biliary pancreatitis related with pregnancy: a 5-year single center experience. Turhan AN, Gönenç M, Kapan S, Islim F, Oner OZ, Tulubas E, Aygun E. Department of General Surgery, Bakirköy Training And Research Hospital, Istanbul, Turkey. ahmetnturhan@gmail.com Ulus Travma Acil Cerrahi Derg. 2010 Mar;16(2):160-4. Abstract BACKGROUND: Pregnancy-associated acute biliary pancreatitis is a rare but challenging clinical entity in terms of diagnosis and management. We report our institutional medical data of pregnancy-associated acute biliary pancreatitis. METHODS: Medical records of 27 patients admitted to our clinics for pregnancy-associated acute biliary pancreatitis between January 2005 and January 2010 were reviewed. RESULTS: Of the 27 patients, 25 (93%) were in the post-partum period, and 2 (7%) were pregnant. Seventeen patients (63%) were managed with conservative treatment, and were scheduled for interval cholecystectomy, while 10 patients (37%) had early cholecystectomy prior to discharge. The mortality rate was 3% (n=1). CONCLUSION: Pregnancy-associated acute biliary pancreatitis usually has a mild-to-moderate clinical course with a favorable outcome, and can be managed successfully with conservative treatment. Early cholecystectomy done prior to discharge in the initial admission should be considered in mild-to-moderate pregnancy-associated acute biliary pancreatitis, except in patients within the first trimester http://www.journalagent.com/pubmed/linkout.asp?ISSN=1306-696X&PMID=20517772  Pancreatitis aguda en el embarazo: un problema no resuelto Acute pancreatitis in pregnancy: an unresolved issue. Jain P. World J Gastroenterol. 2010 Apr 28;16(16):2065-6. Abstract Management of acute pancreatitis in pregnancy is based on expert opinion only, due to geographic and ethic variations. Nonbiliary causes should be sought as they are associated with worse outcomes. Alcohol as a cause of acute pancreatitis is not rare. Hemoconcentration as a marker of fluid deficit and severity should be predicted with caution and fluid resuscitation should be done carefully by closely monitoring the central venous pressure, cardiac and respiratory system. Hypercalcemia of hyperparathyroidism may be falsely lowered due to hypoalbuminemia or suppressed by magnesium tocolysis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860087/pdf/WJG-16-2065.pdf    Manejo endoscópico de las alteraciones biliares durante el embarazo Endoscopic management of biliary disorders during pregnancy. Chong VH, Jalihal A. Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. chongvuih@yahoo.co.uk Hepatobiliary Pancreat Dis Int. 2010 Apr;9(2):180-5. Abstract BACKGROUND: Biliary interventions during pregnancy are associated with risks to both the pregnancy and developing fetus. In this report we summarize our experience with endoscopic interventions including endoscopic ultrasound (EUS) in the management of biliary disorders during pregnancy. METHODS: Endoscopic retrograde cholangiopancreatographies (ERCPs) performed between May 2003 through January 2010 (n=607) were identified from our database, and cases of interventions during pregnancy were reviewed. All procedures were done using conscious sedation and lead shielding. RESULTS: Nine ERCPs (1.5%) were performed in 8 pregnant patients. Their median gestational period was 22 weeks (range, <2-36 weeks). Two, 5 and 2 patients were in their first, second and third trimester, respectively. Indications for ERCP included obstructive jaundice (6 patients) cholangitis (2), and acute pancreatitis/obstructive jaundice (1). Two patients underwent EUS before ERCP. Fluoroscopy was used in 5 ERCPs (median 12 seconds; range 2-20 seconds), and the overall time for a ERCP ranged from 5 to 25 minutes. During ERCP endoscopic sphincterotomy was performed in 5 patients, stenting in 6, and balloon clearance in 3. One procedure caused complication in induction of labor. During pregnancy, there were 4 non-procedure related complications including acute cholecystitis (1), HELLP syndrome resulting in spontaneous abortion (1) and stent migrations (2). Five pregnancies had uncomplicated term deliveries, whereas 2 required urgent caesarian sections (one for fetal distress and 1 for cholangitis secondary to stent migration). One patient was well in her second trimester during follow-up. Seven babies were well at birth with median APGAR scores of 9, and 10 at 5 and 10 minutes, respectively. One baby died of sudden death syndrome at age of 40 days. CONCLUSIONS: ERCP is a safe procedure for pregnant women. It can be conducted for biliary stenting and subsequent clearance after deliveries. EUS has a complementary role. Different strategies can be applied according to the conditions or expertise of endoscopists. http://www.hbpdint.com/upload/PDF/2010410103417158910.pdf

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