An interdisciplinary approach to treatment and delivery in a pregnant woman with acute pancreatitis complicated by pancreonecrosis
Background. To treat patients with pancreonecrosis remains one of the most difficult problems. According to autopsy data, the proportion of pancreatitis ranges from 0.18 to 6%; however, the disease is not always diagnosed in clinical practice. The prevalence of acute pancreatitis among pregnant women is 1 in 4000 women.Andreeva M.V., Popov A.S., Shevtsova E.P., Verovskaya T.A., Shklyar A.L., Tsybizov S.I.
Case report. The paper describes a case of acute pancreatitis and sterile pancreonecrosis that occurred in a patient at 27 weeks’ gestation. After emergency delivery, the patient’s condition remained critical due to extragenital diseases. The postpartum period was complicated by intra-abdominal bleeding as a result of spontaneous separation of a sigmoid-uterine adhesion from the body and uterine angle, which required surgical intervention.
Conclusion. The routing of a high-risk group of pregnant women, intensive combination treatment using high-tech methods in the context of interdisciplinary cooperation allowed a positive outcome to be achieved despite the nature of the disease.
Keywords
pregnancy
acute pancreatitis
pancreonecrosis
interdisciplinary approach
References
- Савельева Г.М., Сухих Г.Т., Серов В.Н. Акушерство и гинекология. Национальное руководство. М.: ГЭОТАР-Медиа; 2019. 1008с. [Savelyeva G.M., Sukhikh G.T., Serov V.N. Obstetrics and gynecology. National leadership. M .: GEOTAR-Media.; 2019. 1088 p. (in Russian)].
- Manohar M., Verma A.K., Upparahalli Venkateshaiah S., Goyal H., Mishra A. Food-induced acute pancreatitis. Dig. Dis. Sci. 2017; 62(12): 3287-97. https://dx.doi.org/10.1007/s10620-017-4817-2.
- Munigala S., Yadav D. Case-fatality from acute pancreatitis is decreasing but its population mortality shows little change. Pancreatology. 2016; 16(4): 542-50. https://dx.doi.org/10.1016/j.pan.2016.04.008.
- Kurti F., Shpata V., Kuqo A., Duni A., Roshi E., Basho J. Incidence of acute pancreatitis in Albanian population. Mater. Sociomed. 2015; 27(6): 376-9. https://dx.doi.org/10.5455/msm.2015.27.376-379.
- Abdullah B., Kathiresan Pillai T., Cheen L.H., Ryan R.J. Severe acute pancreatitis in pregnancy. Case Rep. Obstet. Gynecol. 2015; 2015: 239068. https://dx.doi.org/10.1155/2015/239068. Дубль № 9.
- 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://dx.doi.org/10.1007/s00404-017-4558-7.
- Еремина Е.Ю. Панкреатит у беременных. Экспериментальная и клиническая гастроэнтерология. 2018; 3: 97-104. [Eremina E.Yu. Pancreatitis in pregnant women. Experimental and clinical gastroenterology. 2018; 3: 97-104. (in Russian)].
- Баранюк Н.В., Маисеенко Д.А., Егорова А.Т. Результаты инструментальных методов исследования беременных женщин с заболеваниями панкреатобилиарной системы. Акушерство и гинекология. 2018; 4: 108-12. [Baranyuk N.V., Maiseenko D.A., Egorova A.T. The results of instrumental methods for the study of pregnant women with diseases of the pancreatobiliary system.Obstetrics and gynecology. 2018; 4: 108-12. (in Russian)]. https://dx.doi.org/ 10.18565/aig.2018.4.108-112.
- Скутова В.А., Данилов А.И., Феоктистова Ж.А. Острый панкреатит: актуальные вопросы диагностики и комплексного лечения. Вестник Смоленской государственной медицинской академии. 2016; 15(2): 78-84. [Skutova V.A., Danilov A.I., Feoktistova Zh.A. Acute pancreatitis: Topical issues of diagnosis and complex treatment. Bulletin of the Smolensk State Medical Academy. 2016; 15 (2): 78-84. (in Russian)].
- Mallédant Y., Malbrain M.L.N.G., Reuter D.A. What's new in the management of severe acute pancreatitis? Intensive Care Med. 2015; 41(11): 1957-60. https://dx.doi.org/10.1007/s00134-015-3903-1.
- Vujasinovic M., Makuc J., Tepes B., Marolt A., Kikec Z., Robac N. Impact of a clinical pathway on treatment outcome in patients with acute pancreatitis. World J. Gastroenterol. 2015; 21(30): 9150-5. https://dx.doi.org/10.3748/wjg.v21.i30.9150.
- Шехтман М.М. Руководство по экстрагенитальной патологии у беременных. М.: «Триада»; 2005. 816 с. [Shekhtman M.M. A guide to extragenital pathology in pregnant women. M.: «Triada». 2005; 816. (in Russian)].
- Sun L., Li W., Sun F., Geng Y., Tong Z., Li J. Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study. BMC Pregnancy Childbirth. 2015; 15: 223. https://dx.doi.org/10.1186/s12884-015-0651-8.
- Стяжкина С.Н., Иванова М.К., Акимов А.А., Касимова Н.Р., Ибрагимова Д.Р. Положительный опыт и результат излечения больной с панкреонекрозом в сроки беременности 32 недели. Colloquium-journal. 2019; 10(34): 92-4. [Styazhkina S.N., Ivanova M.K., Akimov A.A., Kasimova N.R., Ibragimova D.R. Positive experience and result of cure of a patient with pancreatic necrosis during pregnancy 32 weeks. Colloquium-journal. 2019; 10(34): 92-4. (in Russian)].
- Стяжкина С.Н., Виноходова Е.М., Коробейникова Г.П., Коробейников В.И., Акимов А.А. Беременность и роды после тяжелой формы панкреонекроза. В кн.: Материалы XXIV Международного Конгресса Ассоциации гепатопанкреатобилиарных хирургов стран СНГ. Конференция «Актуальные проблемы гепатопанкреатобилиарной хирургии. Санкт-Петербург, 19-22 сентября 2017 г. 2017: 219-20. [Styazhkina S.N., Vinokhodova E.M., Korobeinikova G.P., Korobeynikov V.I., Akimov A.A. Pregnancy and childbirth after severe pancreatic necrosis In: Actual problems of hepatopancreatobiliary surgery. Materials of the 24th International Congress of the Association of Hepatopancreatobiliary Surgery of the CIS. 2017: 219-20. (in Russian)].
- Экстрем А.В., Попов А.С., Казанцев Д.А. Управление водными секторами организма при синдроме полиорганной недостаточности (СПОН). Фундаментальные исследования. 2015; 1(10): 2108-12. [Extrem A.V., Popov A.S., Kazantsev D.A. Management of the body's water sectors in multiple organ failure syndrome (SPON). Basic research. 2015; 1 (10): 2108-12.(in Russian)].
- Попов А.С., Экстрем А.В. Шкала оценки волемического статуса пациентов при органной дисфункции. В кн.: Человек и его здоровье – 2018. Актуальные вопросы и инновационные технологии в анестезиологии и реаниматологии. Материалы научно-образовательной конференции. Санкт-Петербург, 30-31 марта 2018 г. 2018: 44-47. [Popov A.S., Extrem A.V. Scale for assessing the volemic status of patients with organ dysfunction Sat: Actual issues and innovative technologies in anesthesiology and resuscitation. Materials of the scientific and educational conference. Public organization "Man and his health". 2018: 44-47. (in Russian)].
- Туровец М.И., Попов А.С., Экстрем А.В., Лопушков А.В. Комплексная профилактика гнойно-септических осложнений у больных со стерильным панкреонекрозом. В кн.: Форум анестезиологов и реаниматологов России (ФАРР-2019). XVIII съезд Федерации анестезиологов и реаниматологов. Москва, 18-20 октября 2019 г. 2019: 315-6. [Turovets M.I., Popov A.S., Extrem A.V., Lopushkov A.V. Comprehensive prevention of purulent-septic complications in patients with sterile pancreatic necrosis. In the book: Forum of Anaesthesiologists and Resuscitators of Russia (FARR-2019) XVIII Congress of the Federation of Anesthesiologists and Resuscitators. 2019: 315-6. (in Russian)].
Received 11.09.2020
Accepted 25.09.2020
About the Authors
Margarita V. Andreeva, Dr. Med. Sci., professor of the Department of Obstetrics and Gynecology, Volgograd State Medical University, Ministry of Health of Russia.Tel.: +7(8442)33-45-56. E-mail: vaa1947@yandex.ru. 400131, Russia, Volgograd, area of the Fallen Fighters, 1.
Alexander S. Popov, MD, professor, Head of the Department of Anesthesiology and Intensive Care, Transfusiology and Emergency Medicine, Institute of Continuing Medical and Pharmaceutical Education, Volgograd State Medical University, Ministry of Health of Russia. Tel.: +7(8442)58-30-50. E-mail: aspopov@volgmed.ru.
400131, Russia, Volgograd, area of the Fallen Fighters, 1.
Elena P. Shevtsova, Cand. Med. Sci., Associate Professor of the Department of Obstetrics and Gynecology, Volgograd State Medical University, Ministry of Health of Russia. Tel.: +7(8442)33-45-56. E-mail: e.p.shevtsova@mail.ru. 400131, Russia, Volgograd, area of the Fallen Fighters, 1.
Tatyana A. Verovskaya, Head physician, Volgograd Regional Clinical Perinatal Center No 2, the chief obstetrician-gynecologist of the Health Committee of the Volgograd region. Tel.: +7(8442)99-07-00. E-mail: vokpc2@vomiac.ru. 400008, Russia, Volgograd, Marshala Vasilevskogo str., 70.
Alexei L. Shklyar, Deputy Chief Physician for clinical and expert work, Volgograd Regional Clinical Perinatal Center No 2. Tel.: +7(8442)34-12-30. E-mail: Vokpc2@yandex.ru.
400008, Russia, Volgograd, Marshala Vasilevskogo str., 70.
Sergey I. Tsybizov, Head of the Surgical Department, Clinical Emergency Medicine Clinic Hospital No. 25. Tel.: +7(8442)59-50-93. E-mail: ho@kb25.ru.
400138, Russia, Volgograd, Zemlyachki str., 74.
For citation: Andreeva M.V., Popov A.S., Shevtsova E.P., Verovskaya T.A., Shklyar A.L., Tsybizov S.I. An interdisciplinary approach to treatment and delivery in a pregnant woman with acute pancreatitis complicated by pancreonecrosis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 12: 218-222 (in Russian)
https://dx.doi.org/10.18565/aig.2020.12.218-222
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