A Rare and Challenging Case of Acute Pancreatitis in Pregnancy - A Case Report

Acute pancreatitis during pregnancy is uncommon but potentially life-threatening for both mother and foetus. Acute exacerbation of pre-existing chronic pancreatitis during pregnancy is rarely reported and poses additional diagnostic and therapeutic challenges. A 30-year-old multiparous woman at 34 weeks of gestation presented with recurrent left upper abdominal pain radiating to the back and vomiting. She had a prior ultrasonographic diagnosis of chronic pancreatitis. Laboratory evaluation showed markedly elevated serum amylase (495 UL) and serum lipase (789 UL). Ultrasonography demonstrated dilatation of the main pancreatic duct with an intraductal calculus, consistent with acute on chronic pancreatitis. The patient was initially managed conservatively with bowel rest, intravenous fluids, analgesics, and close maternalfetal monitoring, resulting in partial clinical and biochemical improvement. Considering persistent symptoms, advanced gestational age, and mechanical effects of the gravid uterus, a multidisciplinary team decided on planned caesarean delivery at 34 weeks and 6 days after antenatal corticosteroid administration. Both maternal and neonatal outcomes were favourable, with complete resolution of symptoms and normalization of pancreatic enzymes at follow-up. This case highlights the importance of individualized, multidisciplinary management of acute chronic pancreatitis in pregnancy. Conservative therapy remains the first-line approach, while timely delivery may be beneficial in selected late-gestation cases to optimize maternal recovery and fetal outcome.