242 Acute biliary pancreatitis occurring in the early postpartum period in a teenage girl: a case report. (11th October 2021)

• Record Type: Journal Article
• Authors: Mašić, Mario; Hojsak, Iva; Jadrešin, Oleg; Mesić, Marko; Kolaček, Sanja; Mišak, Zrinjka
• Is Part Of: Archives of disease in childhood. Volume 106(2021)Supplement 2
• Page Start: A102
• Page End: A102
• Publication Date: 2021-10-11
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2021-europaediatrics.242
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction: Acute biliary pancreatitis during early postpartum period in adolescent pregnancy is a rare, but challenging clinical entity in terms of diagnosis and management. We report a case of acute pancreatitis, occurring in early postpartum period in an adolescent patient who had an otherwise uneventful course of pregnancy. Case Report: A 15-year-old patient presented with a complaint of severe upper abdominal pain with propagation to the back and bilious vomiting, 18 days after delivery of a healthy child. Apart from psychiatric treatment due to behavioral disorder, she was healthy, and the pregnancy was uneventful. The patient was initially examined and admitted to a secondary institution where the diagnosis of acute pancreatitis was established, due to clinical features, elevated amylase values and abdominal ultrasound findings. After primary stabilization, she was transferred to the Intensive Care Unit of our institution. When admitted, the patient was acutely ill, pale, and afebrile, with slow peristalsis and diffuse abdominal pain. Laboratory values of inflammation markers were elevated (CRP 135.4 mg/l, PCT 1.29 ng/mL), with significant increase in lipase (2602 U/L) and amylase in serum (666 U/L) and urine (13593 U/L). Abdominal ultrasound showed enlarged, intumescent pancreas, without necrosis or other focal changes, and multiple concrements in gallbladder, without intrahepatic or extrahepatic duct dilatation, the latter confirmed with magnetic resonance cholangiopancreatography. During hospitalization, patient's condition worsened with the development of a pseudocyst (66 mm in diameter) in the tail of pancreas, free fluid in the abdomen and extensive bilateral pleural effusions, which was treated with antibiotics (meropenem), octreotide for the first three days and parenteral fluid, electrolyte and nutrition supplementation. After stabilization, the patient was admitted to Department of Gastroenterology. On the 14th day, a severe abdominal pain reoccurred with propagation to the back and vomiting, with an increase in inflammatory markers and amylase and lipase values. Abdominal ultrasound showed active pancreatitis with necrotic focal changes in the pancreas. The aforementioned deterioration was inflicted by patient's self-initiated and covert ingestion of nuts and some snacks during the night. After stabilization, laparoscopic cholecystectomy was performed and the patient was discharged. Conclusion: Acute pancreatitis must be kept in mind when evaluating patients presenting with abdominal pain after child delivery, with gallstones being the most common etiological factor. Pregnancy and postpartum associated acute biliary pancreatitis usually has a mild-to-moderate clinical course with a favorable outcome, but can present a challenging clinical entity in adolescence, even posing a survival threat.