Early Diagnosis and Conservative Management of Acute Pancreatitis in the Third Trimester of Pregnancy: A Case Report

Abstract

Acute pancreatitis in pregnancy (APIP) is a potentially serious medico-obstetric emergency; its diagnosis may be challenging due to the overlap of symptoms and physiological changes of pregnancy, which can delay timely treatment and increase risk. This report presents a clinical case of APIP managed at a secondary-level hospital, involving a 28-year-old patient at 33 weeks of gestation who presented with acute epigastric pain, nausea, and vomiting. Clinical evaluation included physical examination, laboratory testing, and abdominal ultrasonography. Laboratory findings demonstrated elevated pancreatic enzyme levels and hypertriglyceridemia, while ultrasonography revealed biliary sludge without evidence of gallstones. The diagnosis was mild acute biliary pancreatitis, and conservative management was initiated, consisting of intravenous hydration, analgesia, pancreatic rest, and continuous multidisciplinary maternal–fetal monitoring. Progressive clinical and biochemical improvement was achieved, leading to hospital discharge. Consequently, the pregnancy progressed to term, with elective cesarean delivery and delayed postpartum cholecystectomy. These findings underscore that a systematic diagnostic approach and timely conservative management of mild acute pancreatitis support expectant treatment and delayed surgical intervention in stable patients during the third trimester of pregnancy. Therefore, APIP requires prompt recognition and multidisciplinary care, as conservative management is safe and effective only when close monitoring and planned postpartum surgical resolution are ensured.