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Necrotizing pancreatitis during pregnancy: A rare cause and review of the literature

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Journal of Gastrointestinal Surgery

Abstract

Acute pancreatitis is an uncommon cause of abdominal pain during pregnancy, and rarely progresses to the necrotizing form of the disease in this clinical setting. Hyperlipidemia is an infrequent cause of acute pancreatitis. Whereas only 100 cases of hyperlipidemia-induced necrotizing pancreatitis have been reported in the literature to date, all of the cases were mild in severity and responsive to conservative medical management. Herein we present a case of life-threatening necrotizing pancreatitis, which developed in a hyperlipidemic pregnant woman and required multiple peripartum pancreatic necrosectomies. Additionally, we review the evaluation of pregnant patients with abdominal pain, the pathophysiology of hyperlipidemia-induced necrotizing pancreatitis, and the operative care of this challenging group of patients, revisiting an innovative technique for management of the retroperitoneum.

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References

  1. Perrone G, Critelli C. Severe hypertriglyceridemia in pregnancy. A clinical case report. Minerva Ginecol 1996;48:573–576.

    PubMed  CAS  Google Scholar 

  2. Block P, Kelly TR. Management of gallstone pancreatitis during pregnancy and the postpartum period. Surg Gynecol Obstet 1989;168:426–428.

    PubMed  CAS  Google Scholar 

  3. Landers D, Carmona R, Crombleholme W, Lim R. Acute cholecystitis in pregnancy. Obstet Gynecol 1987;69:131–133.

    PubMed  CAS  Google Scholar 

  4. Keilson L, Vary C, Sprecher D, Renfrew R. Hyperlipidemia and pancreatitis during pregnancy in two sisters with a mutation in the lipoprotein lipase gene. Ann Intern Med 1996; 124:425–428.

    PubMed  CAS  Google Scholar 

  5. Balthazar EJ. Prognostic value of CT in acute pancreatitis: Is the early CT examination indicated [letter]? Radiology 1987; 162:876–878.

    PubMed  CAS  Google Scholar 

  6. Balthazar EJ. CT diagnosis and staging of acute pancreatitis. Radio1 Clin North Am 1989;27:19–37.

    CAS  Google Scholar 

  7. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174:331–336.

    PubMed  CAS  Google Scholar 

  8. Mazze RI, Kallen B. Appendectomy during pregnancy: A Swedish registry study of 778 cases. Obstet Gynecol 1991;77:835–840.

    PubMed  CAS  Google Scholar 

  9. Glasgow RE, Visser BC, Harris Hw, Patti MG, Kilpatrick SJ, Mulvihill SJ. Changing management of gallstone disease during pregnancy. Surg Endosc 1998;12:241–246.

    Article  PubMed  CAS  Google Scholar 

  10. Maringhini A, Marceno MP, Lanzarone F, Caltagirone M, Fusco G, Di Cuonzo G, Cittadini E, Pagliaro L. Sludge and stones in gallbladder after pregnancy Prevalence and risk factors. J Hepatol 1987;5:218–223.

    Article  PubMed  CAS  Google Scholar 

  11. Ramin K, Ramin S, Richey S, Cunningham R. Acute pancreatitis in pregnancy. Am J Obstet Gynecol 1995;713:187–191.

    Article  Google Scholar 

  12. Swisher SG, Hunt KK, Schmit PJ, Hiyama DT, Bennion RS, Thompson JE. Management of pancreatitis complicating pregnancy. Am Surg 1994;60:759–762.

    PubMed  CAS  Google Scholar 

  13. Corlett R, Mishell D. Pancreatitis in pregnancy. Am J Obstet Gynecol 1972;113:281–290.

    PubMed  Google Scholar 

  14. Parish F, Richardson JB. Acute pancreatitis during pregnancy: With report of a case. Am J Obstet Gynecol 1956;72:906–909.

    PubMed  CAS  Google Scholar 

  15. Knobell R, Castilho LN, Passini R, Parentoni LS, De Faria EC. Hyperlipidemic pancreatitis in a primigravida adolescent. Dig Dis Sci 1998;43:943–944.

    Article  PubMed  CAS  Google Scholar 

  16. Schmidt W. Sammling-Zweifelhafter Schwangerschaft Faille Nebst einer Kritischen Einleitong. Vienna: F. Wimmer, 1818, pp 172–180.

    Google Scholar 

  17. Swoboda K, Derfler K, Koppensteiner R, Langer M, Pam-berger P, Brehm R, Ehringer H, Druml W, Widhalm K. Extracorporeal lipid elimination for treatment of gestational hyperlipidemic pancreatitis [see comments]. Gastroenterology 1993;104:1527–1531.

    PubMed  CAS  Google Scholar 

  18. Saravanan P, Blumenthal S, Anderson C, Stein R, Berkel-hammer C. Plasma exchange for dramatic gestational hyperlipidemic pancreatitis. J Clin Gastroenterol 1996;22:295–298.

    Article  PubMed  CAS  Google Scholar 

  19. Suga S, Tamasawa N, Kinpara I, Murakami H, Kasai N, On-uma T, Ikeda Y, Takagi A, Suda T. Identification of homozygous lipoprotein lipase gene mutation in a woman with recurrent aggravation of hypertriglyceridemia induced by pregnancy. J Intem Med 1998;243:317–321.

    Article  CAS  Google Scholar 

  20. Sanderson SL, Iverius PH, Wilson DE. Successful hyperlipemic pregnancy. JAMA 1991;265:1858–1860.

    Article  PubMed  CAS  Google Scholar 

  21. Steinberg F, Thai E, Bnmzell J, Chait A. ApoE enhances lipid uptake by macrophages in lipoprotein lipase deficiency during pregnancy. J Lipid Res 1996;37:972–984.

    PubMed  CAS  Google Scholar 

  22. Weinberg RB, Sitrin MD, Adkins GM, Lin CC. Treatment of hyperlipidemic pancreatitis in pregnancy with total parenteral nutrition. Gastroenterology 1982;83:1300–1305.

    PubMed  CAS  Google Scholar 

  23. Miller A, Lees RS, McCluskey MA, Warshaw AL. The natural history and surgical significance of hyperlipemic abdominal crisis. Arm Surg 1979;190:401–408.

    Article  CAS  Google Scholar 

  24. Ma Y, Ooi T, Lui M, Zhang H, McPherson R, Edwards A, Forsythe I, Frohlich J, Brumzell J, Hayden M. High frequency of mutations in the human lipoprotein lipase gene in pregnancy-induced chylomicronemia: Possible association with apolipoprotein E2 isoform. J Lipid Res 1994;35:1066–1075.

    PubMed  CAS  Google Scholar 

  25. De Chalain T, Michell W, Berger G. Hyperlipidemia, pregnancy and pancreatitis. Surg Gynecol Obstet 1988;167:469–473.

    PubMed  Google Scholar 

  26. Knopp R, Bergelin R, Wahl P, Walden C, Chapman M, Irvine S. Population-based lipoprotein lipid reference values for pregnant women compared to nonpregnant women classified by sex hormone usage. Am J Obstet Gynecol 1982;143:626–637.

    PubMed  CAS  Google Scholar 

  27. Sanderson S, Iverius P, Wilson D. Successful hyperlipemic pregnancy. JAMA 1991;265:1858–1860.

    Article  PubMed  CAS  Google Scholar 

  28. Henderson H, Leisegang F, Hassan F, Hayden M, Marais D. A novel Glu42 1Lys substitution in the lipoprotein lipase gene in pregnancy-induced hypertriglyceridemic pancreatitis. Clin Chim Acta 1998;269:1–12.

    Article  PubMed  CAS  Google Scholar 

  29. Lermertz A, Parhofer KG, Samtleben W, Bosch T. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Ther Apher 1999;3:227–233.

    Article  Google Scholar 

  30. Bret M, Berard P, Ray MJ, Michel AJ, Guillemin G. [Pregnancy and severe pancreatitis (author’s transl)]. J Gynecol Obstet Biol Reprod (Paris) 1978;7:77–85.

    CAS  Google Scholar 

  31. Femandez-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL. Debridement and closed packing for tbe treatment of necrotizing pancreatitis [see comments]. Ann Surg 1998;228:676–684.

    Article  Google Scholar 

  32. Mier J, Leon EL, Castillo A, Robledo F, Blanco R. Early versus late necrosectomy in severe necrotizing pancreatitis [see comments]. Am J Surg 1997;173:71–75.

    Article  PubMed  CAS  Google Scholar 

  33. Bradley EL. A fifteen year experience with open drainage for infected pancreatic necrosis. Surg Gynecol Obstet 1993;177:215–222.

    PubMed  Google Scholar 

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Correspondence to Hobart W. Harris M.D., M.E.H..

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Gosnell, J.E., O’Neill, B.B. & Harris, H.W. Necrotizing pancreatitis during pregnancy: A rare cause and review of the literature. J Gastrointest Surg 5, 371–376 (2001). https://doi.org/10.1016/S1091-255X(01)80064-0

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  • DOI: https://doi.org/10.1016/S1091-255X(01)80064-0

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