Getting the gist: What is the importance of molecular genetics in gastro-intestinal stromal tumours (GIST)

The pregnant patient with abdominal pain poses a unique diagnostic and therapeutic challenge to the surgeon, obstetrician and patient. Pancreatitis in pregnancy is a rare event estimated to occur in approximately 3 per 10 000 pregnancies. Acute pancreatitis occurs more frequently with advancing gestational age and in multiparous women. The spectrum of acute pancreatitis is no different from the non pregnant state. It varies from a mild attack to severe pancreatitis with multiple organ dysfunction syndromes and local complications such as pseudocysts and sterile or infected necrosis. In the era preceding endoscopic retrograde cholangiopancreatography (ERCP) and laparascopic cholecystectomy, outcomes were poor, with reported maternal and fetal mortality rates of 20% and 50% respectively. Improved outcomes especially with regard to acute gallstone pancreatitis in pregnancy have been reported as a result of improved abdominal imaging and minimally invasive therapeutic techniques with zero maternal mortality and under 5% perinatal mortality. Recommendations in the literature rely on various studies, often in relatively small retrospective cohorts accrued over long time spans. It is unlikely randomized prospective controlled trials will be carried out for these reasons and that therapy is always based on current best practice available in the interests of the mother and fetus. This review evaluates the most current literature to formulate a management guideline.