SEVERE HYPERTRIGLYCERIDEMIAINDUCED ACUTE PANCREATITIS COMPLICATED WITH PERIPANCREATIC COLLECTION IN PREGNANCY

Abstract

INTRODUCTION/BACKGROUND
Acute pancreatitis in pregnancy is rare and may result in severe complications and high mortality. Elevated oestrogen levels and insulin resistance during pregnancy may lead to raised triglyceride levels, which can precipitate acute pancreatitis. We report a case of severe hypertriglyceridemia-induced acute pancreatitis complicated with peripancreatic abscess in a pregnant patient.

CASE
A 35-year-old female, G3P0+2 at 28 weeks period of gestation (POG), with a strong family history of dyslipidaemia, was admitted due to acute onset of epigastric pain and vomiting associated with shortness of breath for two days. She was electively intubated due to worsening metabolic acidosis. Initial blood results revealed elevated serum amylase at 840 IU/ml. Abdominal CECT demonstrated a bulky pancreas with free fluid at the peripancreatic region, suggesting acute pancreatitis. Further workup revealed severe hypertriglyceridemia of >32.1 mmol/L, and her capillary blood sugar ranged from 9 to 11 mmol/L. She was kept Nil by mouth and was initiated on an intravenous insulin infusion with dextrose solution. She had preterm labour on day 2 of admission. She was started on a low-fat diet and fenofibrate postpartum. Her triglyceride level reduced significantly and finally normalized on day 6 of admission. She was discharged well until nine days after discharge; she presented with right flank pain and low-grade fever. CT of the abdomen revealed extensive multiloculated rim-enhancing peripancreatic collection suggestive of pancreatic abscess. She proceeded with image-guided drainage and started on empirical antibiotic coverage. Her symptoms improved after six days of drainage, and she was discharged well.

CONCLUSION
Hypertriglyceridemia-induced pancreatitis in pregnancy is associated with high maternal and foetal morbidity and mortality. A multidisciplinary approach, including an obstetrician, endocrinologist, surgeon and radiologist, is needed to provide the best supportive care for the patient to reduce triglyceride levels rapidly to ensure good outcomes.