Acute fatty liver of pregnancy causes severe acute pancreatitis and stillborn fetus

Abstract

Rationale: Acute fatty liver of pregnancy (AFLP) is a potentially fatal obstetric emergency characterized by acute hepatic failure secondary to fatty infiltration. The resultant effects include coagulopathy, electrolyte abnormalities, and multisystem organ dysfunction. Pancreatitis typically develops after the onset of renal and hepatic dysfunction. Pancreatitis has been suggested as a poor prognostic indicator because it is associated with more adverse outcomes. Patient concerns: A 29-year-old Chinese woman at 34.7 weeks pregnancy was admitted to hospital due to paroxysmal hypogastric pain and massive colporrhagia for 1 day. Diagnosis: Laboratory tests revealed hepatic and renal impairment, coagulopathy. Thoracoabdominal computed tomography (CT) scanning showed pleural and peritoneal effusion, fatty liver, and pancreatitis. She was diagnosed with AFLP, severe acute pancreatitis (SAP), multiple organ dysfunction syndrome (MODS), and intrauterine fetal death. Interventions: The patient was treated with blood component transfusions, plasma exchange combined with renal replacement therapy, antibiotic de-escalation, gastric and pancreatic secretion inhibitor, and enteral nutrition. Outcomes: After successful management, the patient was discharged without any complications on day 35 of admission. At 10 months follow-up, thoracoabdominal enhanced CT revealed was normal and laboratory tests revealed normal liver and kidney function. Lessons: Once AFLP is highly suspected or confirmed, the pregnancy should be terminated in time and active symptomatic management should be given.

Evaluation of Inflammatory Infiltration in the Retroperitoneal Space of Acute Pancreatitis Using Computer Tomography and Its Correlation with Clinical Severity

“…There are many studies on PE in China. At present, it mainly holds the view that peripancreatic inflammation spreads from the extrapancreatic to the pleural cavity to form PE [ 28 ]. It is generally believed that anatomically, the lymphatic plexus around the transverse septum is connected with the mediastinal and subcostal spaces, the giant inflammatory cells formed by AP spread into the mediastinum and subcostal space through the lymph plexus around the septum, and the pancreatic enzyme effusion containing soluble tissue gradually entered the chest cavity.…”

Emerging Pathological Events in Liver Diseases of Pregnancy

“…Extended prothrombin time (PT) and decreased fibrinogen levels are common in severe cases and disseminated intravascular coagulation (DIC) occurs in about 10% of AFLP patients (Meng et al, 2016). Ascites, pleural effusions, severe pancreatitis, and respiratory and renal failure are all possible complications of AFLP (Ye et al, 2021). Because women with AFLP are prone to having coagulopathies as a consequence of poor synthetic liver function and/or DIC, infections, as well as vaginal bleeding or bleeding from Caesarean section wounds, are prevalent (Mikolasevic et al, 2018).…”