Challenges encountered in the management of gall stones induced pancreatitis in pregnancy.

Background: Though uncommon, acute biliary pancreatitis in pregnancy carries a potential of serious and life threatening complications to mother and foetus. The management of acute pancreatitis in pregnancy is challenging due to the complexity of physiological and anatomical changes. This becomes even more challenging when invasive interventions are urgently needed. Therefore, there have been various debates among clinicians on the type and timing of these interventions. We systematically reviewed the evidences that looked into these debates to formulate a list of recommendations for clinical practice.

Methods: An electronic literature search of the databases (Medline/Pubmed, EMBASE, Cochrane database, NICE guidelines and Google Scholar) using the keywords "pancreatitis, pancreatitis in pregnancy, biliary pancreatitis, laparoscopy in pregnancy, and gall stones in pregnancy" was conducted. The relevant studies were screened and full text versions were retrieved. The references to all the retrieved texts were searched for further relevant studies. All studies were systematically reviewed and critically analysed.

Conclusion: The available published literature on management of gall stones induced acute pancreatitis in pregnancy was solely based on retrospective studies and case series. The management of biliary induced pancreatitis in pregnant patients is challenging and complex, and it should involve the input of highly skilled clinicians from different specialities. Each case should be individually and thoroughly assessed by weighing the risks against the benefits. The authors have formulated a list of recommendations for clinical practice that is based on this comprehensive review of the literature.