Management of necrotizing pancreatitis in the third trimester of pregnancy

Acute pancreatitis during pregnancy is a severe disease with a high materno-fetal mortality, which recently decreased because of earlier diagnosis and improvement in maternal and neonatal intensive care. We describe a 19-year-old woman who presented at 37 weeks gestation with acute abdominal pain and attacks of vomiting. Obstetrical and fetal examinations were normal. Biochemical investigations and magnetic resonance imaging showed a gallstone migration with necrotizing pancreatitis (Balthazar 5 points). Our multidisciplinary team decided on nonsurgical conservative treatment including morphine administration and enteral feeding, and vaginal delivery which was possible 30 h after induction of labor. Follow up was uneventful with a resolution of pain and signs of pancreatitis on imaging. Magnetic resonance imaging can be useful and safe to estimate the severity of acute and necrotizing pancreatitis in the third trimester of pregnancy. In case of sterile necrotizing pancreatitis, nonsurgical conservative treatment and a vaginal delivery should be performed when possible in these patients to reduce the risk of maternal infection.