Pancreatitis Secondary to Bile Duct Cyst in a 36-year-old Pregnant Woman: Case Report
Luis Angel Medina Andrade1*, Reyes Coot1, Carla Hernandez1, Stephanie Serrano Collazos1, Angeles Martinez1, Laura Medina Andrade2, Alejandro Medina Andrade3, Grecia Ortiz3, Oscar Montes1, Staphanny Woolf1 and Israel López1
- *Corresponding Author:
- Luis Angel Medina Andrade, M.D.
General Surgery Department. Instituto Mexicano del Seguro Social
Hospital General Regional No. 17
Servicio de Cirugía General
Av. Politécnico Manzana 1 Lote 1 Región 509 C.P. 55750
Cancún, Quintana Roo, Mexico
E-mail: [email protected]
Received Date: May 18, 2015; Accepted Date: July 20, 2015; Published Date: July 27, 2015
Citation: Andrade LAM, Coot R, Hernandez C, Collazos SS, Martinez A, et al. (2015) Pancreatitis Secondary to Bile Duct Cyst in a 36-year-old Pregnant Woman: Case Report. Emerg Med (Los Angel) 5:272. doi:10.4172/2165-7548.1000272
Copyright: © 2015 Andrade LAM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Pancreatitis in pregnancy has a prevalence of 1.5/1500-4500 cases, constituting one of the most common acute abdomen wedges, with biliary origin in 70% of cases, triglycerides in 20% and other causes in the remaining 10%, including choledochal cyst (CC) as a rare cause with three previous reports in literature, which may have a fatal outcome with fetal loss in some cases. We report the case of a 25-year-old patient with 30.4 weeks of gestation (WOG) that arrived to emergency room with right upper quadrant and epigastric pain for the last 8 hours, associated with nausea and vomiting. No pathological background referred. At physical examination with jaundice, gravidic abdomen for 30.4 WOG pregnant, fetal movements presents, Murphy (+) and epigastric pain on deep palpation. Laboratories report total bilirubin (TB) 3.9 mg/dl and direct bilirubin (DB) 3.69 mg/dl Alkaline phosphatase (AP) 2038 IU/L Amylase 280 IU/L Lipase 1938 IU/L. Pancreatitis is confirmed and abdominal ultrasound (US) is requested to determine biliar origin. USG reports gallbladder of 9×4 cm, thin walls without filling defects, dilated intrahepatic bile duct and common bile duct cyst. Cholangiopancreatography Resonance Imaging (CPMR) concludes Todani I choledochal cyst of 17×9 cm, with displacement of duodenum, colon and páncreas. Due to gestation ongoing appropriate medical management with fluids and analgesics was started until remission of pancreatitis 72 hours later. After delivery at 34 WOG, cholecystectomy was performed with hepático-jejunum Roux-Y anastomosis successfully. Histopathologic analisis reports inespecific inflammation without displasia or metaplasia. At four months follow-up patient is asymptomatic. Pancreatitis in pregnancy is a common cause of acute abdomen, rarely associated with choledochal cysts as the cause. Surgical resolution once pregnancy is over must be done as soon as possible by the high risk of adenocarcinoma degeneration and recurrent pancreatitis.