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Acute pancreatitis is an inflammatory condition of pancreas and can be fatal. Even with great advances in critical care medicine over the past 20 years, the mortality rate due to acute pancreatitis remained at approximately 10%. Diagnosis of pancreatic related problem is often difficult and management is often difficult and is delayed as the pancreas is an organ which is relatively inaccessible especially in pregnant women. It is often difficult to diagnose acute pancreatitis in a pregnant patient even more so in a patient with underlying gastritis presenting with sudden pain at epigastric region sometimes extending to the back. The common cause of acute pancreatitis in pregnancy is often due to alcohol abuse or gall bladder. It is thought with the weight and hormonal changes induced by pregnancy, gallstones are more likely to form and thus travel down the common bile duct to obstruct the pancreas duct outflow.
A 31 year old, Malay female G3P0+2 at 26 weeks 5 days presented to the emergency department with the chief complaint of sudden onset of epigastric pain radiating to the back, on and off sharp in nature with a pain score of 8/10. The pain was relieved by leaning forward. This was associated with multiple episodes of vomiting for one day containing water and food particles. Patient had no history of eating outside food or skipping meals. The vital signs upon arrival were noted within normal range. Patient looked lethargic with epigastric tenderness with a pain score of 8/10. Urine dipstick showed albumin: 2+, ketone: 1+, leucocyte:1+. FBC noted WCC: 30.9, Hb: 12.2, Plt:384, Hct: 35, RP and LFT noted within normal range. Initially patient was referred to O&G team and then to Surgical and Gastroenterology team with a working diagnosis of Acute Gastritis and TRO Acute Pancreatitis. Subsequently serum amylase noted 1608 and ultrasound abdomen showed cholelithiasis with bulky and heterogenous pancreas with no peripancreatic fluid or collection and acute pancreatitis cannot be ruled out due to raised amylase level. Patient was discharged after close monitoring at the medical ward and the serum amylase level has decreased. A follow up with surgery in 6 weeks time was given for reassessment and planned for gall bladder removal post pregnancy.
While a rare event, acute pancreatitis does occur in pregnancy. Fortunately, if treated early, generally pre-term labor and mortality can be avoided and the incidence of recurrent attacks minimized. Therefore, it is important to rapidly detect and diagnose for appropriate and early management for optimal results for both mother and baby. Emergency physicians should consider establishing acute pancreatitis as a diagnosis when such cases are seen on set.
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