Peculiarities of early diagnosis and tactics of treatment in an acute pancreatitis in pregnant women

Keywords: pregnancy; acute pancreatitis; diagnosis; treatment.

Abstract

Objective. Improvement of the treatment results of an acute pancreatitis in pregnant women, using enhanced early diagnosis and tactics of treatment.

Маterials and methods. Analysis of the diagnosis and treatment results was conducted in 123 pregnant women, suffering an acute pancreatitis. In the main group (61 pregnant women) the elaborated algorithm of diagnosis and treatment for an acute pancreatitis in the period 2012 - 2018 yrs was applied, while in a comparison group (62 pregnant women) - the standard methods of diagnosis and treatment in an acute pancreatitis for the period of 2006 - 2012 yrs.

Results. In the main group in 100% of the patients an acute pancreatitis was revealed on early stage. This have had guaranteed the effect obtaining from the conservative therapy in 27 (44.3%) pregnant women, using miniinvasive surgical interventions - in 31 (50.8%) and to prevent postoperative lethality. In a comparison group in 26 (41.9%) patients an acute pancreatitis diagnosis was established in (8 ± 2.1) days after the disease beginning.

In a comparison group the conservative treatment effect was observed in 21 (33.9%) patients only. Two (3.2%) pregnant women died.

Conclusion. Application of the diagnostic-treatment algorithm, comparing with standard methods, permits to diagnose an acute pancreatitis in pregnant women on early stage, to reduce the complications and lethality rate.

Author Biographies

Ya. P. Feleshtynskyi, Shupyk National Medical Academy of Postgraduate Education, Kyiv

Yaroslav.P. Feleshtynskyi, MD, PhD, professor,
Head of Department of Surgery and Proctology,
Shupyk National Medical Academy of Postgraduate Education.
Address: 9 Dorogozhytska Str., 04112, Kyiv, Ukraina,
tel.: 38(044)42-98-27
E-mail: surgeryproctology@ukr.net
ORCID http://orcid.org/0000-0002-8794-456X

О. V. Golyanovskyi, Kyiv Regional Centre for the Mother and Child Health Defense

Oleg.V.Golyanovskyi, MD, PhD, professor,
Head of Department of Obstetrics and Gynecology №1,
Shupyk National Medical Academy of Postgraduate Education.
Address: 9 Dorogozhytska Str., 04112,, Kyiv, Ukraina,
tel.: 38(044)489-49-35
E-mail: obstet.gynec@gmail.com
ORCID http://orcid.org/0000-0001-7344-5746

Т. P. Pavliv, Shupyk National Medical Academy of Postgraduate Education, Kyiv

Tetiana.P.Pavliv, graduate student,
Department of Surgery and Proctology,
Shupyk National Medical Academy of Postgraduate Education.
Address: 9 Dorogozhytska Str., 04112,, Kyiv, Ukraina,
tel.: 38(050)728-22-80
E-mail: teaaana@gmail.com
ORCID http://orcid.org/0000-0003-3608-7403

References

1. Tenner S, Baillie J, DeWitt J, Swaroop S. Vege, American College of Gastroenterology. Am J Gastroenterol. 2013 Sep;108(9):1400-16. Published online 2013 Jul 30. doi: 10.1038/ajg.2013.218.
2. Bereznytskyi YaS, Duka RV. Rezultaty likuvannia patsiientiv z hostrym pankreatytom v umovakh bahatoprofilnoho khirurhichnoho statsionaru. Zbirnik naukovikh prats spivrobitikiv NMAPO imeni P. L. Shupyka. 2014;23(2);54-61. [In Ukrainian].
3. Feleshtynskyi YaP, Bondarenko MD, Bondarchuk BH, Karpenko OV. Analiz rezultativ likuvannia hostroho pankreatytu v Kyivskii oblasti. Khirurhiia Ukrainy. 2016;(3):44-9. [In Ukrainian].
4. Ducarme G, Maire F, Chatel P, Luton D, Hammel P. Acute pancreatitis during pregnancy: a review. J Perinatol. 2014 Feb;34(2):87-94. Published online 2013 Dec 19. doi: 10.1038/jp.2013.161.
5. Dronov AI, Kovalskaja IA, Uvarov VYu. Osobennosti patogeneticheskogo podhoda k lecheniju ostrogo nekroticheskogo pankreatita. Ukraїnskiy zhurnal hіrurhії. 2013;(3):145-9. [In Russian].
6. Shcherbakov VI. Uroven interlejkina-6, rastvorimyh receptorov interlejkina-6 isosudisto-jendotelial’nogo faktora rosta pri srochnyh rodah, ugroze prezhdevremennyh rodov i prejeklampsii. Akusherstvo i ginekologija. 2017;(3):50-4. [In Russian].
7. Mamchich VI, Goljanovskij OV, Kandaurova IV, Pilipenko TJu, Josipenko MA, Litvinec YuO. Osobennosti diagnostiki i lechenija ostrogo pankreatita u beremennyh. Hirurgija Ukrainy. 2015;(4):28-32. [In Russian]
8. Kopchak KV, Duvalko AV, Pererva LA, Davidenko NG, Kvasivka AA, Suhachev SV. First experience of laparoscopic no-touch pancreaticoduodenectomy. Klinichna hirurhiia. 2013;(9):73-4. [In Russian].
9. Gompertz, Macarena, Lara, Ivone, Fernández, Lara et al. Mortality of acute pancreatitis in a 20 years period. Revista médica de Chile. 2013;141(5):562-7. doi:10.4067/S0034-98872013000500002.
10. Rohan Jeyarajah D, Osman HG, Patel S. Severe acute pancreatitis attacks are associated with significant morbidity and mortality. Curr Probl Surg. 2014;51(9):370-2. doi: 10.1067 / j.cpsurg.2014.07.002.
11. Eremina EYu. Pankreatit u beremennyh. Prakticheskaja medicina. 2012;(3):58. [In Russian].
12. Wilcox CM, Varadarajulu S, Morgan D, Christein J. Progress in the management of necrotizing pancreatitis. Expert Rev Gastroenterol Hepatol. 2010 Dec;4(6):701-8. doi:10.1586/egh.10.75.
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;62:102-11. doi:10.1136/gutjnl-2012-302779.
Published
2018-07-26
Section
General Problems of Surgery