Title: Acute Pancreatitis and Pregnancy: A Report of 13 Cases and a Review of the Literature
Authors: A.Khattabi ,O.Bouchama , M.Benhaddocu Idrissi ,N. Mamouni',S.Errarhay,C. Bouchikhi', A.Banani'
Volume: 9
Issue: 7
Pages: 39-45
Publication Date: 2025/07/28
Abstract:
Acute pancreatitis during pregnancy is a rare condition. Through this study, we aim to provide an update on acute gravido-puerperal pancreatitis, clarify its etiopathogenesis, and highlight the specificities of its diagnostic and therapeutic management. The objective of our study is to report the experience of the Department of Gynecological and Obstetric Surgery at Hassan II Hospital in Fez in managing acute pancreatitis during pregnancy. We aim to determine the epidemiological characteristics of this association, establish diagnostic criteria (positive diagnosis, severity assessment, etiological diagnosis), describe the therapeutic management approaches implemented in our institution, and finally, evaluate maternal and fetal prognosis. This is a retrospective, descriptive, and analytical study including 13 pregnant patients admitted for acute pancreatitis between January 2020 and December 2023 at the Department of Gynecological and Obstetric Surgery at Hassan II Hospital in Fez. During the study period, 13 patients were admitted for the management of pancreatitis associated with pregnancy. The mean age of our patients was 26 years. Acute pancreatitis was more frequent in multigravida multiparous patients (70%), with the highest occurrence in the second trimester (40%). The clinical presentation was dominated by abdominal pain (100%) and vomiting (80%).The diagnosis was based on serum lipase levels, which were on average 19 times higher than normal. The severity assessment was based on clinical-biological scores and radiological scoring. Biliary origin was the most common etiology in our study (70%). Management was based on hospitalization in the intensive care unit or our department, with symptomatic treatment, including pain management, cessation of oral intake, gastric protection, rehydration, and organ failure management, as well as etiological treatment. The occurrence of gallstone disease and biliary sludge formation is favored by pregnancy and represents the most frequent cause of acute pancreatitis during gestation. There are specific treatment options available; when indicated, ERCP and laparoscopic cholecystectomy appear to be safe for pregnant women. Hypertriglyceridemia and primary hyperparathyroidism, both promoted by pregnancy, are very rare causes of acute pancreatitis. These conditions require specific treatments. Maternal and fetal prognosis depends on several factors. In conclusion, pregnancy is not a direct cause of acute pancreatitis but modifies the distribution of its etiologies. Early diagnosis through enzymatic assays (lipase levels) enables rapid multidisciplinary management, with informed consent from the patient. Advances in diagnostic and therapeutic methods have improved both maternal and fetal prognosis.