E0074 - A Rare Case of Necrotizing Pancreatitis in the Postpartum Period

Paloma Velasco, MD¹, Karelys Burgos Irizarry, MD², Gabriela M. Negron-Ocasio, MD³, Marcel Mesa, MD^4
1University of Puerto Rico, Internal Medicine Program, San Juan, Puerto Rico; ²University of Puerto Rico School of Medicine Internal Medicine Program, San Juan, Puerto Rico; ³University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico; ⁴University of Puerto Rico School of Medicine, San Juan, Puerto Rico

Introduction: Postpartum pancreatitis is a rare condition occurring in approximately 3 in 10,000 pregnancies. Progression to the necrotizing form of the disease leads to an increased mortality of up to 25%. High clinical suspicion is warranted in postpartum patients that present with abdominal pain and normal pancreatic enzymes in order to emergently diagnose and treat necrotizing pancreatitis.

Case Description/Methods: A 28 years old G2P2A0 female presented with diffuse abdominal pain, nausea, diarrhea, bilious emesis and poor oral intake two weeks after an uneventful cesarean delivery. Vital signs were remarkable for tachycardia and hypotension. Laboratories revealed leukocytosis, lactatemia and acute kidney injury. Lipid panel, pancreatic enzymes and liver function enzymes were within normal limits. Abdominopelvic computed tomography was remarkable for necrotizing pancreatitis with near complete devitalization of the pancreas and a partial rim enhancement in the lesser sac extending into the pericolic gutter, gastrosplenic recess and superior duodenal fossa. Abdominal ultrasound revealed dilatation of the common biliary duct with no visible intraluminal calculi and no intrahepatic biliary duct dilatation. Magnetic resonance cholangiopancreatography showed severe pancreatic inflammation with common biliary duct compression. Imaging guided percutaneous drainage was successfully performed with significant decrease in abscess size. Patient was placed on pancreatic enzyme replacement and broad spectrum intravenous antibiotics. Hospitalization course was complicated with pancreatogenic diabetes, hypernatremia with osmotic extrapontine myelinolysis, respiratory failure and septic shock. Work-up for causes of pancreatitis such as drug-induced, gallstone, autoimmune, alcohol-induced, infectious, among others, was negative. Follow up imaging showed sterile walled off pancreatic necrosis with marked clinical improvement for which patient was discharged with multidisciplinary care team follow up.

Discussion: This report contributes to a better understanding of an atypical cause of abdominal pain in the subacute postpartum period. Recognition of necrotizing pancreatitis in this population may be easily missed since clinical manifestations of pancreatitis tend to overlap with other diseases such as endometritis, septic pelvic thrombophlebitis, and wound infection. Idiopathic pancreatitis is seen in 10-15% of pancreatitis cases for which emergent clinical recognition and treatment are crucial to ensure survival.


Disclosures:


Paloma Velasco, MD¹, Karelys Burgos Irizarry, MD², Gabriela M. Negron-Ocasio, MD³, Marcel Mesa, MD⁴. E0074 - A Rare Case of Necrotizing Pancreatitis in the Postpartum Period, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.