Acute Pancreatitis and Cholecystitis Associated with Postpartum HELLP Syndrome: A Case and Review

Abstract

We report a case of preeclampsia associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and concomitant nonbiliary acute pancreatitis and cholecystitis in the first postpartum day. A thorough investigation ruled out known etiologies of both pancreatitis and cholecystitis. Following conservative treatment, the patient's HELLP syndrome, pancreatitis, and cholecystitis resolved on the third postpartum day. Preeclampsia is associated with microvascular abnormalities that may involve the splanchnic circulation. These abnormalities may cause not only HELLP syndrome but also pancreatitis and cholecystitis. Recognizing that ischemia can damage not only the liver but also the pancreas and gallbladder, could result in improvements in the diagnosis and management of pancreatitis in patients with preeclampsia.

Maternal and fetal outcomes of pancreatitis in pregnancy

“…20 Although the exact causal and temporal relationship of pancreatitis and preeclampsia has not been established, increasingly, case reports and small studies in the literature have attempted to demonstrate an association. [10][11][12][13][14][15][16][17] Our findings of an association between hypertensive disease and pancreatitis during pregnancy corroborate these publications.…”

Necrotizing Pancreatitis Associated With Severe Preeclampsia

“…He reports five maternal deaths and four cases of intrauterine fetal demise, all before 1973. 5 Hojo's case is similar to ours in that the patient had significant multiorgan insult with hemolysis (LDH 3,770 units/ L), thrombocytopenia (platelet count 28ϫ10 3 /microliter), proteinuria (1.67 g/d), and hypertension (blood pressures of 160 -220 and 100 -120 mm Hg). The diagnosis of acute pancreatitis was based on imaging studies performed on postpartum day 1, when the patient developed acute right upper quadrant pain and fever.…”

“…She made a complete clinical and radiographic recovery by the sixth postpartum day. 5 If pancreatitis is suspected, confirmation is made by documenting elevated plasma levels of amylase and lipase. If severe acute pancreatitis is diagnosed, based on well-established scoring systems such as Ranson criteria or the APACHE II, imaging studies should be considered.…”

Early pancreatic panniculitis associated with HELLP syndrome and acute fatty liver of pregnancy

“…To our knowledge, pancreatic panniculitis has not been reported in association with either of these disorders. Although pancreatitis rarely complicates pregnancy, both HELLP syndrome and acute fatty liver of pregnancy have known associations with acute pancreatitis 13,14 . The underlying mechanism is probably due to alterations in splanchnic circulation 14 …”