Ayoub Mark, Ceesay Muhammed, Faris Carol, Iannetti Michael
Internal Medicine, West Virginia University School of Medicine, Charleston, USA.
Internal Medicine, Charleston Area Medical Center, Charleston, USA.
Cureus. 2023 Dec 22;15(12):e50945. doi: 10.7759/cureus.50945. eCollection 2023 Dec.
A common cause of gastrointestinal-related hospitalizations in the United States of America is acute pancreatitis (AP), with an annual incidence of up to 80 cases per 100,000 people. The incidence of AP in pregnancy varies and is approximately 1 in 1000 to 1 in 10,000 births due to the prevalence of obesity and gallstone-related conditions. Deciding on the timing of surgical intervention in acute biliary pancreatitis during pregnancy remains challenging, and there are no consensus recommendations. Gallstone pancreatitis has a high recurrence rate of up to 50% during the first trimester. A 30-year-old G3P2 at 34 weeks of gestation presented to the emergency room (ER) with recurrent intermittent sudden severe epigastric and right upper quadrant abdominal pain radiating to the back. She had no history of alcohol consumption, and lipid studies were normal on presentation. A right upper quadrant ultrasound scan showed cholelithiasis without signs of acute cholecystitis and a common bile duct diameter of 0.5 cm. However, her serum lipase level was 824, compared to normal levels on her previous ER visits. Other significant labs included elevated alkaline phosphatase (ALP) of 125 and mild transaminitis, with alanine transaminase (ALT) and aspartate aminotransferase (AST) levels of 84 and 57, respectively. She was admitted on account of suspected gallstone pancreatitis and was treated supportively with IV fluids and adequate pain control with opioids. A subsequent magnetic resonance cholangiopancreatography (MRCP) revealed no obvious choledocholithiasis. After consultation with the obstetrics, gastroenterology, and general surgery teams, it was decided to defer cholecystectomy until after delivery. The patient was induced at 36 weeks of gestation, and she had an uneventful vaginal delivery. Two weeks later, she had an elective laparoscopic cholecystectomy with no complications.
在美国，胃肠道相关住院的一个常见原因是急性胰腺炎（AP），年发病率高达每10万人80例。由于肥胖和胆结石相关疾病的普遍存在，妊娠期AP的发病率有所不同，约为每1000至10000例分娩中有1例。决定妊娠期急性胆源性胰腺炎的手术干预时机仍然具有挑战性，并且没有共识性建议。胆结石性胰腺炎在孕早期的复发率高达50%。一名30岁、孕34周、孕3产2的孕妇因反复间歇性突发严重上腹部和右上腹疼痛并放射至背部而就诊于急诊室。她无饮酒史，就诊时血脂检查正常。右上腹超声扫描显示有胆结石但无急性胆囊炎迹象，胆总管直径为0.5厘米。然而，她的血清脂肪酶水平为824，而之前急诊就诊时该水平正常。其他重要实验室检查结果包括碱性磷酸酶（ALP）升高至125以及轻度转氨酶升高，谷丙转氨酶（ALT）和谷草转氨酶（AST）水平分别为84和57。她因疑似胆结石性胰腺炎入院，接受了静脉输液支持治疗，并使用阿片类药物进行了充分的疼痛控制。随后的磁共振胰胆管造影（MRCP）未发现明显的胆总管结石。在与产科、胃肠病学和普通外科团队会诊后，决定将胆囊切除术推迟至分娩后。该患者在孕36周时引产，顺产过程顺利。两周后，她接受了择期腹腔镜胆囊切除术，无并发症发生。
