Zheng Lu, Wang Dingxi, Li Guixiang, Zhao Xianlin, Yang Rong
West China School of Nursing, Sichuan University/Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China.
Ann Transl Med. 2022 Aug;10(16):911. doi: 10.21037/atm-22-3313.
Hypertriglyceridemia (HTG) is an important cause of acute pancreatitis (AP) in pregnant women. Due to the variable clinical features of acute pancreatitis, it is difficult to make a differential diagnosis when abdominal pain occurs in late pregnancy. Severe HTG induced acute pancreatitis during pregnancy is rare, but may be a fatal threat to both mothers and fetuses during the peripartum period, and can increase maternal and fetal mortality. If emotional disorder combined, difficulty of treatment increased. So, multidisciplinary diagnosis combination of psychiatric treatment could improve the diagnosis rate and cure rate of acute pancreatitis during pregnancy.
We present the case of a 27-year-old Chinese woman in her first pregnancy, who was admitted to the hospital in the planned delivery period, but then developed progressive abdominal pain and whose biochemistry parameters were high enough to underwent a cesarean section as a result of AP a few hours after admission. The patient developed organ failure after a successful labor, which rapidly evolved to multi-organ failure, accompanied by depressive symptoms. Afterwards She appeared such as agitated, uneasy, and sad, and did not comply with the treatment, according to the classification of symptoms and course of disease, postpartum depression (PPD) was highly suspected. The patient benefited from multidisciplinary treatments that combined and integrated traditional Chinese medicine (TCM) with Western medicine therapies. The patient was discharged 35 days after her admission.
This case highlights the importance of monitoring and managing excess dyslipidemia during pregnancy. A proactive strategy should be encouraged in the management of the patients with high risk of pancreatitis to improve the outcomes of patients. Our case report elucidates the possible long-term effects of HTG and reminds us of the need for long-term management of those affected.
高甘油三酯血症(HTG)是孕妇急性胰腺炎(AP)的重要病因。由于急性胰腺炎的临床特征多变,妊娠晚期出现腹痛时很难进行鉴别诊断。妊娠期严重HTG诱发的急性胰腺炎较为罕见,但在围产期可能对母亲和胎儿都构成致命威胁,并可增加母婴死亡率。若合并情绪障碍,治疗难度增加。因此,多学科诊断结合精神科治疗可提高妊娠期急性胰腺炎的诊断率和治愈率。
我们报告一例27岁首次妊娠的中国女性病例,她在计划分娩期入院,但随后出现进行性腹痛,入院数小时后因AP导致生化指标升高而接受剖宫产。患者分娩成功后出现器官功能衰竭,并迅速发展为多器官功能衰竭,伴有抑郁症状。之后她表现出烦躁、不安和悲伤,且不配合治疗,根据症状和病程分类,高度怀疑为产后抑郁症(PPD)。患者受益于中西医结合的多学科治疗。患者入院35天后出院。
本病例强调了孕期监测和管理血脂异常的重要性。在胰腺炎高危患者的管理中应鼓励采取积极主动的策略,以改善患者的预后。我们的病例报告阐明了HTG可能产生的长期影响,并提醒我们需要对受影响者进行长期管理。