Korean J Obstet Gynecol.  2010 Jun;53(6):535-539. 10.5468/kjog.2010.53.6.535.

A case of acute pancreatitis induced by hypertriglyceridemia in gestational diabetes

• Kim GH
• Jun HA
• Song JE
• Lee KY
• Kim SS

• KMID: 2273895
• DOI: http://doi.org/10.5468/kjog.2010.53.6.535

Abstract

Hypertriglyceridemia is a rare cause of pancreatitis in pregnancy. Pregnancy is related with hypertriglyceridemia especially in the 3rd trimester due to increase of estrogen. Diabetes is known as a common cause of secondary lipid metabolism disorder and is often associated with hypertriglyceridemia. Shock and sepsis related to pancreatitis in pregnancy result in a relatively high morbidity and mortality rate for both the mother and the fetus. Hypertriglyceridemic pancreatitis complicated in gestational diabetes has not previously been reported. We report a case of 26(+4) weeks gestational aged primigravida with acute pancreatitis induced by hypertriglyceridemia in gestational diabetes. We reviewed the clinical courses and treatments of acute pancreatitis in pregnancy with the literatures.

Keyword

Gestational diabetes; Hypertriglyceridemia; Acute pancreatitis

MeSH Terms

Aged
Diabetes, Gestational
Estrogens
Female
Fetus
Humans
Hypertriglyceridemia
Lipid Metabolism Disorders
Mothers
Pancreatitis
Pregnancy
Sepsis
Shock
Estrogens

Figure

• 

  Figure 1 Abdominal ultrasound revealed acute pancreatitis. A swelling of pancreas (arrow) with decreased echo of pancreatic parenchyma and peripancreatic fluid collection (white arrow).

• 

  Figure 2 Abdominal computed tomography showing acute pancreatitis. A swelling of pancreas (arrow) with peripancreatic infiltration and fluid collection (white arrow) is representing acute pancreatitis.

Reference

1. Nanda S, Gupta A, Dora A. Acute pancreatitis: a rare cause of acute abdomen in pregnancy. Arch Gynecol Obstet. 2009. 279:577–578.

2. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003. 36:54–62.

3. Montgomery WH, Miller FC. Pancreatitis and pregnancy. Obstet Gynecol. 1970. 35:658–664.

4. McKay AJ, O'Neill J, Imrie CW. Pancreatitis, pregnancy and gallstones. Br J Obstet Gynaecol. 1980. 87:47–50.

5. Chang CC, Hsieh YY, Tsai HD, Yang TC, Yeh LS, Hsu TY. Acute pancreatitis in pregnancy. Zhonghua Yi Xue Za Zhi (Taipei). 1998. 61:85–92.

6. Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis: presentation and management. Curr Opin Lipidol. 2009. 20:497–504.

7. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995. 90:2134–2139.

8. Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am. 1990. 19:783–791.

9. Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med. 1969. 15:117–154.

10. Kimura W, Mossner J. Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats. Int J Pancreatol. 1996. 20:177–184.

11. Farmer RG, Winkelman EI, Brown HB, Lewis LA. Hyperlipoproteinemia and pancreatitis. Am J Med. 1973. 54:161–165.

12. Swoboda K, Derfler K, Koppensteiner R, Langer M, Pamberger P, Brehm R, et al. Extracorporeal lipid elimination for treatment of gestational hyperlipidemic pancreatitis. Gastroenterology. 1993. 104:1527–1531.

13. Knopp RH, Warth MR, Charles D, Childs M, Li JR, Mabuchi H, et al. Lipoprotein metabolism in pregnancy, fat transport to the fetus, and the effects of diabetes. Biol Neonate. 1986. 50:297–317.

14. Neill AM, Hackett GA, Overton C, Byrne CD. Active management of acute hyperlipidaemic pancreatitis in pregnancy. J Obstet Gynaecol. 1998. 18:174–175.

15. Kayatas SE, Eser M, Cam C, Cogendez E, Guzin K. Acute pancreatitis associated with hypertriglyceridemia: a life-threatening complication. Arch Gynecol Obstet. 281:427–429.

16. Sanderson SL, Iverius PH, Wilson DE. Successful hyperlipemic pregnancy. JAMA. 1991. 265:1858–1860.

17. Young KR. Acute pancreatitis in pregnancy: two case reports. Obstet Gynecol. 1982. 60:653–657.

18. Lykkesfeldt G, Bock JE, Pedersen FD, Meinertz H, Faergeman O. Excessive hypertriglyceridemia and pancreatitis in pregnancy. Association with deficiency of lipoprotein lipase. Acta Obstet Gynecol Scand. 1981. 60:79–82.