妊娠第1期に発症した特発性急性膵炎の一例

A Case of Idiopathic Acute Pancreatitis in the First Trimester of Pregnancy.

抄録

妊娠中の急性膵炎はまれであり、その発生率は約1000～10000妊娠に1回と推定される。妊娠中の急性膵炎は通常，妊娠第3期に発症する．今回，我々は妊娠第1期に急性膵炎を発症した1例を報告する．妊娠11週目の36歳の初産婦が激しい下腹部痛を訴えた．痛みは徐々に悪化し，心窩部へ移行した．慢性アルコール中毒の既往はない．血液検査ではCRP（9.58mg/dL）、膵アミラーゼ（170IU/L）、リパーゼ（332IU/L）が高値であった。超音波検査では胆石はなく，膵管，胆道にも異常はなかった．抗核抗体，IgG4は陰性で，高脂血症，糖尿病の所見は認められなかった．また、ウイルス感染の所見もなかった。入院3日目にMRIで重症急性膵炎と診断された．メシル酸ナファモスタットとウリナスタチンによる内科的介入を開始し，中心静脈カテーテルによる非経口栄養を投与した．入院8日目に膵アミラーゼが低下し，疼痛も消失したため，徐々に病状が改善した．保存的管理の後，妊娠中に再発することはなかった。

Acute pancreatitis is rare in pregnancy, with an estimated incidence of approximately 1 in 1000 to 1 in 10,000 pregnancies. Acute pancreatitis in pregnancy usually occurs in the third trimester. Here, we report a case of acute pancreatitis in the first trimester. A 36-year-old primigravida at 11 weeks of gestation complained of severe lower abdominal pain. The pain gradually worsened and migrated toward the epigastric region. She had no history of chronic alcoholism. Blood investigations showed elevated level of C-reactive protein (9.58 mg/dL), pancreatic amylase (170 IU/L), and lipase (332 IU/L). There was no gallstone and no abnormality in the pancreatic and biliary ducts on ultrasonography. Antinuclear antibody and IgG4 were negative and no evidence of hyperlipidemia or diabetes was found. There was also no evidence of viral infection. On the third day of hospitalization, she was diagnosed with severe acute pancreatitis on magnetic resonance imaging. Medical interventions were initiated with nafamostat mesilate and ulinastatin, and parenteral nutrition was administered through a central venous catheter. On the eighth day of hospitalization, her condition gradually improved with a decreased level of pancreatic amylase and the pain subsided. After conservative management, she did not have any recurrence during her pregnancy.