Gallstone and Severe Hypertriglyceride-Induced Pancreatitis in Pregnancy

Cain, Mary Ashley; Ellis, J. D.; Vengrove, Marc A.; Wilcox, Benjamin R.; Yankowitz, Jerome; Smulian, John C.

doi:10.1097/ogx.0000000000000216

Cited by 11 publications

(7 citation statements)

References 52 publications

(105 reference statements)

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“…In this population-based case-control study, high serum LDL levels and low levels of HDL were significantly associated with an increased risk of biliary calculus. This finding supports the role of serum lipids in gallstones and biliary carcinogenesis, which is consistent with previous cross-sectional and prospective studies of serum lipid and gallstones showing that high TG and low cholesterol levels are associated with gallstone risk [17][18][19][20][21].…”

Section: Discussionsupporting

confidence: 92%

Serum lipid levels are the risk factors of gallbladder stones: a population-based study in China

et al. 2020

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Background: Gallstones are the cause of a majority of biliary tract discomfort. Although many community-based studies have addressed the risk factors for gallstone disease (GSD), little is known about GSD prevalence and risk factors in Chinese populations. , participants (N = 2,068,523) were recruited by Meinian Onehealth Healthcare Co., Ltd. They received a physical examination, and GSD was determined by ultrasound. Results: The prevalence of GSD was 8.1%. Risks of GSD were similar between males and females in all age groups. Risk factors for gallstones include body mass index, waist circumference, waist-to-hip ratio, and physical activity, as well as biological factors such as age, sex, and elevated blood lipid levels. Serum lipid levels of GSD were statistically different from controls in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (H-DL), lowdensity lipoprotein cholesterol (LDL), and apolipoprotein B (APOB). Furthermore, TC > 5.00 mmol/L, TG > 1.39 mmol/L, HDL < 1.19 mmol/L, LDL > 3.04 mmol/L, and APOB > 0.97 mmol/L were risk factors for gallstones. Conclusions: Serum lipid levels are associated with GSD. TC, TG, LDL, and APOB are risk factors, while HDL is a protective factor.

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Section: Discussionsupporting

confidence: 92%

Serum lipid levels are the risk factors of gallbladder stones: a population-based study in China

et al. 2020

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“…Several mechanisms are involved in the pathogenesis of acute pancreatitis; in the last trimester, cholesterol secretion exceeds the levels of bile acids, leading to the formation of cholesterol crystals and calcification. [11] Along with this, progesterone causes relaxation of the gallbladder smooth muscles, increasing biliary stasis and gallstone formation. Although diseases related to biliary stones are common among the population in Turkey, cholecystectomy is performed in the last treatment of symptomatic patients regardless of their pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Management of Gallstone Induced Acute Pancreatitis in Pregnancy: a Tertiary Center Experience

Sarıcı

Kalaycı

2018

Sisli Etfal

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A cute pancreatitis in pregnancy is a relatively common problem. The incidence is almost 1/1000-10.000 pregnancies. [1, 2] It can be caused by gallstones, idiopathic hyperlipidemia, alcohol abuse, and, less commonly by, hyperparathyroidism, trauma, and medications. [1-3] Gallbladder stones are the most frequently reported etiology and are often diagnosed in the third trimester. [1-3] Acute pancreatitis is classified into mild, moderate, and severe forms. Mild and moderate forms are the most common presentations, and the established guidelines recommend cholecystectomy during the same admission in non-pregnant patients with gallstone-induced pancreatitis. [4] However, for patients who develop severe acute biliary pancreatitis, especially with necrotizing pancreatitis, the decision regarding the timing of cholecystectomy is a complex one and prolongs the treatment process. On Objectives: Gallbladder stones are the most frequently reported etiology of acute pancreatitis in pregnancy and are often diagnosed in the third trimester. This condition is associated with both mother and infant morbidity and mortality, and its treatment remains controversial. Methods: Relevant patient data between September 2010 and April 2017 from the Kanuni Sultan Suleyman Training and Research Hospital were analyzed regarding etiology (of gallstone pancreatitis), trimester of pregnancy, diagnostic tools, pancreatitis stage, clinical status, medical treatment, surgical interventions, and pregnancy status. Results: We included 68 patients recorded with acute pancreatitis due to biliary gallstones. Pancreatitis symptoms developed in most (n=38) (55.8%) patients during the third trimester. Of 24 patients who had their first episode of pancreatitis in the first trimester of pregnancy, 12 (50%) were readmitted due to recurrence. Seven (11.3%) patients whose Ranson scale score was 3 underwent computed tomography evaluation. The number of patients with acute cholecystitis with pancreatitis was 5 (7.3%), whereas the number of patients with choledocholithiasis was 4 (5.8%). Sphincterotomy with endoscopic retrograde cholangiopancreatography was performed in 2 (2.9%) patients. Laparoscopic cholecystectomy was performed in 9 (13.2%) patients during pregnancy. No fetal and maternal morbidity and mortality was found in all periods. Conclusion: Developments in supportive care, widespread use of imaging methods, and a multidisciplinary approach with better antenatal care of pregnant patients with acute pancreatitis can help prevent fetal and maternal morbidity and mortality in such cases. Early laparoscopic cholecystectomy should be considered especially in pregnant patients with acute pancreatitis due to gallstones in the first trimester.

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“…Fetal outcomes have improved due to progress and development in neonatal intensive care. (3,7) However, fetal mortality related to pancreatitis remains signi cant, primarily due to an increased risk of prematurity and intrauterine fetal death. (5) A case of missed diagnosis, masked by suspicion of uterine rupture, has been reported, resulting in fetal demise.…”

Section: -9 11-13)mentioning

confidence: 99%

Severe fetal distress and acute maternal pancreatitis secondary to severe hypertriglyceridemia: A case report.

Garin,

Bridier-Petit,

Ménard

et al. 2024

Preprint

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- Background : Acute pancreatitis during pregnancy is a rare condition and a potential cause of maternal-fetal mortality. Its diagnosis can be challenging. Hypertriglyceridemia is one of the causes. We describe a case of severe fetal distress in the third trimester of pregnancy, associated with severe hypertriglyceridemia complicated by acute pancreatitis. - Case presentation : A 35-year-old pregnant patient at 36 weeks gestation presented to the emergency department with acute epigastric pain. After excluding preeclampsia and initially challenging laboratory analyses, a diagnosis of acute pancreatitis was made based on a lipase level 12 times the normal range. The etiology was hypertriglyceridemia at 40 times the normal level. Despite initial conservative management, the patient deteriorated rapidly clinically, and severe fetal distress necessitated an emergency cesarean section. Lactescent blood appearance was observed intraoperatively. We suspect that the severe and rapid hypertriglyceridemia may have caused acute fetal hypoxia. - Conclusions : Acute pancreatitis during pregnancy is a rare condition, with significant maternal-fetal mortality. Early diagnosis remains challenging. A multidisciplinary approach is necessary for optimal management, with special consideration for rapid fetal delivery in cases of acute pancreatitis secondary to hypertriglyceridemia due to the increased risk of fetal mortality.

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Gallstone and Severe Hypertriglyceride-Induced Pancreatitis in Pregnancy

Cited by 11 publications

References 52 publications

Serum lipid levels are the risk factors of gallbladder stones: a population-based study in China

Serum lipid levels are the risk factors of gallbladder stones: a population-based study in China

Management of Gallstone Induced Acute Pancreatitis in Pregnancy: a Tertiary Center Experience

Severe fetal distress and acute maternal pancreatitis secondary to severe hypertriglyceridemia: A case report.

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