c Pancreatitis aguda idiopática grave en el embarazo, manejo multidisciplinario en Terapia Intensiva Obstétrica: reporte de un caso

Rev Med UAS
Rev Med UAS; Vol. 15 No. 3. Julio-Septiembre 2025
ISSN 2007-8013

Pancreatitis aguda idiopática grave en el embarazo, manejo multidisciplinario en Terapia Intensiva Obstétrica: reporte de un caso

Severe idiopathic acute pancreatitis in pregnancy; multidisciplinary manage-ment in obstetric intensive care: A case report

Carlos Uriel Reyes-Reyes1*, Alberto Moreno-González1, Karina Jennifer Quintero-Beltran2, Carlos Ernesto Mora-Palazuelos3, Perla Yareli Gutiérrez-Arzapalo3, Paúl González-Quintero1, Marco Aurelio Espero-Cárdenas2

  1. Servicio de Ginecología y Obstetricia, Hospital de la Mujer. Servicios de Salud de Sinaloa, Culiacán, Sinaloa, México.
  2. Unidad de Cuidados Intensivos, Hospital de la Mujer. Servicios de Salud de Sinaloa, Culiacán, Sinaloa, México.
  3. Unidad de Investigación, Centro de Investigación y Docencia en Ciencias de la Salud. Universidad Autó-noma de Sinaloa, Culiacán, Sinaloa, México.

*Autor de correspondencia: Carlos Uriel Reyes-Reyes, MD
Miguel Tamayo Espinoza de los Monteros s/n, Desarrollo Urbano Tres Ríos, 80020 Culiacán Rosales, Sinaloa, México.
Email: urielreyes_30@hotmail.com ORCID: 0009-0001-2012-8840

DOI http://dx.doi.org/10.28960/revmeduas.2007-8013.v15.n3.008

Texto Completo PDF

Recibido 05 de marzo 2025, aceptado 09 de junio 2025

RESUMEN
Se presenta un caso clínico de pancreatitis aguda idiopática grave en una gestante sin factores de riesgo, quien requiere de manejo multidisciplinario en el área de terapia intensiva. Es primigesta quien ingresa de 33 semanas de gestación con cuadro de dolor abdominal intenso, se realiza protocolo diagnostico evidenciando pancreatitis aguda con falla multiorgánica (falla respiratoria, renal y hepática). Mediante cesárea se encuentra producto óbito, realizando además histerectomía subtotal obstétrica. Fue requerido de soporte hemodinámico y ventilatorio, reanimación con líquidos cristaloides y transfusión de hemoderivados. El diagnostico de pancreatitis aguda incluye un reto para el gineco-obstetra al descartar las causas más comunes, utilizando pruebas diagnósticas de serología e imagenología. A pesar de que no existe un consenso internacional el manejo en el embarazo se debe realizar por un equipo multidisciplinario y deben utilizarse las escalas pronosticas de la población en general e incluir intervenciones farmacológicas, endoscópicas y quirúrgicas.
Palabras clave: Embarazo; pancreatitis aguda; síndrome de respuesta inflamatoria sistémica; pancreatitis idiopática. .

ABSTRACT
A clinical case of severe idiopathic acute pancreatitis in a pregnant woman without risk factors is presented, requiring multidisciplinary management in the intensive care unit. She is a primigravida who was admitted at 33 weeks of gestation with intense abdominal pain. A diagnostic protocol was carried out, revealing acute pancreatitis with multiorgan failure (respiratory, renal, and hepatic failure). Through cesarean section, a stillborn fetus was found, and a subtotal obstetric hysterectomy was performed. Hemodynamic and ventilatory support, along with crystalloid fluid resuscitation and blood transfusions, were required. The diagnosis of acute pancreatitis poses a challenge for the obstetrician in ruling out the most common causes, using diagnostic tests such as serology and imaging. Although there is no international consensus, management during pregnancy should be conducted by a multidisciplinary team and use prognostic scales for the general population, including pharmacological, endoscopic, and surgical interventions.
Keywords: Pregnancy; acute pancreatitis; systemic inflammatory response syndrome; idiopathic pancreatitis.

Referencias

  1. CENETEC. Prevención, diagnóstico, tratamiento y pronóstico de la pancreatitis aguda. Guía de Práctica Clínica: Evidencias y Recomendaciones. Centro Nacional de Excelencia Tecnológica en Salud; 2022.
  2. Luo L, Zen H, Xu H, Zhu Y, Liu P, Xia L, et al. Clinical characteristics of acute pancreatitis in pregnancy: experience based on 121 cases. Arch Gynecol Obstet. 2018;297(2):333-9. https://doi.org/10.1007/s00404-017-4558-7
  3. Mądro A. Pancreatitis in Pregnancy-Comprehensive Review. Int J Environ Res Public Health. 2022;19(23). https://doi.org/10.3390/ijerph192316179
  4. Maringhini A, Dardanoni G, Fantaci G, Patti R, Maringhini M. Acute Pancreatitis During and After Pregnancy: Incidence, Risk Factors, and Prognosis. Dig Dis Sci. 2021;66(9):3164-70. https://doi.org/10.1007/s10620-020-06608-5
  5. Pandey R, Jacob A, Brooks H. Acute pancreatitis in pregnancy: review of three cases and anaesthetic management. Int J Obstet Anesth. 2012;21(4):360-3. https://doi.org/10.1016/j.ijoa.2012.07.004
  6. Boukatta B, Sbai H, Laalim SA, Toughrai I, Houari N, El Bouazzaoui A, et al. [Acute pancreatitis in postpartum: report of a case]. Pan Afr Med J. 2013;15:2. https://doi.org/10.11604/pamj.2013.15.2.2359
  7. Kucharek-Stawirej M, Walenda O, Gąsiorowska A. Choroby trzustki u kobiet w ciąży. Postępy Nauk Med. 2018:52-60. https://doi.org/10.25121/PNM.2018.31.2A.52
  8. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1-15. https://doi.org/10.1016/j.pan.2013.07.063
  9. Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, Štimac D, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. Cochrane Database Syst Rev. 2015;2015(2):Cd011548. https://doi.org/10.1002/14651858.Cd011548
  10. Masselli G, Brunelli R, Casciani E, Polettini E, Bertini L, Laghi F, et al. Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdom Imaging. 2011;36(5):596-603. https://doi.org/10.1007/s00261-010-9654-0
  11. Al Samaraee A, Bhattacharya V. Challenges encountered in the management of gall stones induced pancreatitis in pregnancy. Int J Surg. 2019;71:72-8. https://doi.org/10.1016/j.ijsu.2019.09.016
  12. Keller D, Hardin EM, Nagula SV, Royek A. Hypertriglyceridemia-Induced Acute Pancreatitis During Pregnancy: A Case Report. Cureus. 2022;14(8):e28273. https://doi.org/10.7759/cureus.28273
  13. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. https://doi.org/10.1136/gutjnl-2012-302779
  14. Nanda S, Gupta A, Dora A, Gupta A. Acute pancreatitis: a rare cause of acute abdomen in pregnancy. Arch Gynecol Obstet. 2009;279(4):577-8. https://doi.org/10.1007/s00404-008-0755-8
  15. Ducarme G, Maire F, Chatel P, Luton D, Hammel P. Acute pancreatitis during pregnancy: a review. J Perinatol. 2014;34(2):87-94. https://doi.org/10.1038/jp.2013.161
  16. Marshall JB. Acute pancreatitis. A review with an emphasis on new developments. Arch Intern Med. 1993;153(10):1185-98. https://doi.org/10.1001/archinte.153.10.1185
  17. Gyang A, Kalu E, Fakokunde A, Whitlow B. Ascites in the puerperium: a missed diagnosis of acute postpartum pancreatitis. Arch Gynecol Obstet. 2005;272(3):238-40. https://doi.org/10.1007/s00404-004-0717-8
  18. Anees F, Khan RS, Naz S, Wadani ZH. Acute Pancreatitis in Pregnancy and Puerperium: Assessing Maternal and Fetal Impact, Etiologies, and Clinical Outcomes at a Tertiary Care Hospital in Pakistan. Cureus. 2024;16(12):e76393. https://doi.org/10.7759/cureus.76393
  19. Cruciat G, Nemeti G, Goidescu I, Anitan S, Florian A. Hypertriglyceridemia triggered acute pancreatitis in pregnancy - diagnostic approach, management and follow-up care. Lipids Health Dis. 2020;19(1):2. https://doi.org/10.1186/s12944-019-1180-7
  20. Hughes DL, Hughes A, White PB, Silva MA. Acute pancreatitis in pregnancy: meta-analysis of maternal and fetal outcomes. Br J Surg. 2021;109(1):12-4. https://doi.org/10.1093/bjs/znab221
  21. Ölmez Ş, Sarıtaş B, Yalçın MS, Narin R, Taş A, Öztürk NA, et al. A retrospective study of pregnant patients with acute pancreatitis. Rev Assoc Med Bras (1992). 2024;70(1):e20230810. https://doi.org/10.1590/1806-9282.20230810
  22. Tang M, Xu JM, Song SS, Mei Q, Zhang LJ. What may cause fetus loss from acute pancreatitis in pregnancy: Analysis of 54 cases. Medicine (Baltimore). 2018;97(7):e9755. https://doi.org/10.1097/md.0000000000009755
  23. Kumar MP, Singh AK, Samanta J, Birda CL, Kumar N, Dhar J, et al. Acute pancreatitis in pregnancy and its impact on the maternal and foetal outcomes: A systematic review. Pancreatology. 2022;22(2):210-8. https://doi.org/10.1016/j.pan.2021.12.007
  24. Avsar AF, Yildirim M, Cinkaya A. Unexpected fetal demise despite the reactive nonstress test during the conservative management of acute pancreatitis in pregnancy. Int J Surg Case Rep. 2014;5(12):1047-9. https://doi.org/10.1016/j.ijscr.2014.10.075
  25. Cheang CU, Ho SW, Tee YT, Su CF, Chen GD. Acute necrotizing pancreatitis complicating uteroplacental apoplexy. Taiwan J Obstet Gynecol. 2007;46(1):64-7. https://doi.org/10.1016/s1028-4559(08)60110-2