Simultaneous endoscopic and laparoscopic management of acute biliary pancreatitis in the second trimester of pregnancy: A case report.

INTRODUCTION AND IMPORTANCE

Acute biliary pancreatitis during pregnancy is a rare but significant clinical challenge that requires a delicate balance between maternal and fetal safety. Gallstone disease remains among the leading causes of acute pancreatitis in pregnancy due to hormonal and physiological changes that predispose pregnant women to biliary stasis and sludge formation. While conservative management is often preferred in mild cases, persistent biliary obstruction or recurrent symptoms necessitate definitive intervention. ERCP and laparoscopic cholecystectomy have emerged as safe and effective modalities for managing gallstone-related complications during pregnancy.

CASE PRESENTATION

We present a case of a 30-year-old pregnant at 18 weeks of gestation who presented with acute-onset, progressively worsening epigastric pain radiating to the back associated with nausea and bilious vomiting but no fever. Laboratory investigations revealed elevated serum amylase and lipase, consistent with acute biliary pancreatitis, alongside obstructive biochemical features on liver function tests. Imaging confirmed multiple gallstones, choledocholithiasis, and a dilated common bile duct (CBD). She underwent successful ERCP with sphincterotomy and stone extraction followed by laparoscopic cholecystectomy in the same session. The patient had an uneventful recovery and was discharged on postoperative day three without complications.

CLINICAL DISCUSSION

The second trimester is considered the safest period for surgical intervention, given the lower risk of fetal loss compared to the first trimester and reduced risk of preterm labor relative to the third trimester. ERCP is the gold standard for managing choledocholithiasis in pregnancy, with fluoroscopy-minimizing techniques employed to mitigate fetal radiation exposure. Laparoscopic cholecystectomy has demonstrated superior outcomes in terms of reduced postoperative morbidity, shorter hospital stays, and faster recovery compared to open surgery. This case underscores the importance of a multidisciplinary approach, incorporating gastroenterology, surgery, and obstetric expertise, to optimize outcomes in pregnant patients with biliary pancreatitis.

CONCLUSION

This case highlights the role of timely diagnosis and intervention in managing biliary pancreatitis during pregnancy. ERCP and laparoscopic cholecystectomy, when performed in the second trimester, provide a safe and effective treatment strategy, preventing recurrent disease and reducing maternal-fetal morbidity. As evidence supporting minimally invasive procedures in pregnancy continues to grow, standardized guidelines are needed to further refine management strategies and ensure optimal patient care.