MTP5.12 Gallstone Pancreatitis in the peri- partum period: experience in an emergency surgery service in a tertiary centre

Introduction Gallstone disease (GD) is the second most common cause of non-obstetric acute abdominal pain in pregnancy. Fluctuating hormonal levels result in increased incidence of GD in the 3rd trimester and up to 2 years post-partum. Re-occurrence rate in complicated GD with pancreatitis is high with significant adverse foetal/maternal outcomes, emphasising the importance of adequate and timely care. Methods Review of case-notes of female patients aged 16-45, admitted with confirmed gallstone pancreatitis (GSP) between October 2022-2024. Patients admitted pregnant or within 2 years of delivery were included. Results 24 patients (median age 30.8; range 23.0-43.9 years), 87.5 days peri-partum (-65 to 525 days) had confirmed GSP. 11 patients (45.8%) had previously been referred to surgical services for non-obstetric abdominal pain during pregnancy or post-partum, prior to index admission. Median time from admission to laparoscopic cholecystectomy (LC) was 34 days (range 5-92) for 20 patients: 3 patients (12.5%) received emergency LC; 1 (4.2%) during subsequent admission within 30 days of discharge, and 15 (75%) had elective LC. At the end of follow up, 4 patients did not undergo LC due to patient request or need for further outpatient investigations. Importantly, one third of patients in the cohort had emergency caesarean section. Conclusion This review highlights obstacles in offering definitive management (LC) as per international guidelines. These include diagnostic challenges, multi-disciplinary nature of care and personal factors and preferences contributing to delayed presentation. There remains a need to explore formal multi-disciplinary approaches to reduce risk of adverse outcomes, improving patient experience.