CLINICAL CASES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2005 October;164(5):427-30

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English

Severe hyperlipemic pancreatitis in pregnancy: a case report

Palermo P. ¹, Patacchiola F. ¹, Di Stefano L. ¹, Di Ferdinando A. ¹, Poccia G. ², Coppola G. ¹, Mascaretti G. ¹

¹ Division of Gynecology and Obstetrics, Department of Surgery, University of L’Aquila, L’Aquila, Italy; ² Centro Antidiabetico, Ospedale Civile San Salvatore, L’Aquila, L’Aquila, Italy

Acute pancreatitis is an inflammatory disease due to going out of pancreated activated enzymes from the ductal system. This disease is characterized by elevation of the pancreatic enzymes in the serum and in the urines that evolves to a distruction more or less diffused of the gland. The factors that could cause an acute pancreatitis are different. Acute pancretaitis in pregnancy is rare. Its incidence is about 1/4 000 and there is a very high mortalità both for the mother (21%) and for the fetus (20%). In pregnancy the most frequent cause of acute pancretaitis is certainly hyperlipemia (56%), the other frequent cause is the lithiasis (37.5%). A negative factor is the physiological gestational hyperlipemia, infact in this period the levels of cholesterol and triglycerides increase of the 23% and of the 53% respectively. The clinical picture is habitually dominated from intense ephigastric abdominal pain radiated to the back, nausea and vomit. These symptoms join with a cleare increase of urinary and serum of amylases, and with a strong leucocitosis, with a reduction of the calcemia and of the magnesemia. A woman of 38 years old with a pregnancy at risk came in our Department in january 2002, at 12° weeks of gestation. In her first pregnancy she was submitted to a cesarian section urgently, on account of acute pancreatitis at 35° weeks of gestational age. The fetus was born dead and during the same procedure the woman was subjected to a pancreatic necrosectomy and profilattic colecistectomy. She was affected by a familiar hypertriglyceridemia IV-V joint with a partil reduction in lipoprotein lipasi activity due to a mutation in the LPL gene. To study the patient by multidisciplinary approach she was submitted to surgical, diabetologic and medical advice. Her therapy was a combination of diet therapy, nutritional support with medium chain triglycerides and well planned preterm cesarean delivery. We believe that this combination therapy is an effective measure to prevent gestational hyperlipemic pancreatitis and leads to successful childbirth.