Review of a Challenging Clinical Issue: Acute Biliary Pancreatitis During Pregnancy

Acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by gallstone. Approximately 70% cases of acute pancreatitis during pregnancy are secondary to gallstones or sludge. Acute pancreatitis is a rare complication with a reported incidence of one per 1.500-4.500 pregnancies. Gallstones cause bile duct obstruction and pancreatic hyperstimulation. These processes lead to increased hydrostatic pressure, trypsin reflux and activation of digestive enzymes within the pancreas and cause autodigestion of pancreas, followed by local inflammation. During pregnancy, the steroid hormones of pregnancy affect the gallbladder motility and bile content. Progesterone induces gallbladder smooth muscle relaxation and estrogens increase bile cholesterol level, enhancing bile stasis. The clinical symptoms include pain in the right upper abdominal area and/or epigastric area, which can radiate to the right flank, scapula and shoulder, anorexia, nausea, vomiting, dyspepsia, low-grade fever and sinus tachycardia, hyperventilation and smell of acetone in the breath. The diagnosis of acute pancreatitis in pregnancy is confirmed by laboratory investigations and imaging methods. The management of acute biliary pancreatitis during pregnancy is similar on a large scale