A Case of Idiopathic Severe Acute Pancreatitis following Cesarean Section Delivery

Jung Kim; Jin Ho Choi; Bang Sup Shin; Joon Yeul Nam; Eun Ae Kang; Joo Seong Kim; Jin Hyeok Hwang; Jaihwan Kim

doi:10.4166/kjg.2016.68.3.161

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Kim, Choi, Shin, Nam, Kang, Kim, Hwang, and Kim: A Case of Idiopathic Severe Acute Pancreatitis following Cesarean Section Delivery

Case Report

Korean J Gastroenterol 2016;68(3):161-165.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.3.161

A Case of Idiopathic Severe Acute Pancreatitis following Cesarean Section Delivery

Jung Kim, Jin Ho Choi, Bang Sup Shin, Joon Yeul Nam, Eun Ae Kang, Joo Seong Kim, Jin Hyeok Hwang¹, Jaihwan Kim¹

Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

¹Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Correspondence to: Jaihwan Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel: +82-31-787-7075, Fax: +82-31-787-4290, E-mail: drjaihwan@snu.ac.kr

Received 25 March 2016 Revised 27 June 2016 Accepted 15 July 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute pancreatitis rarely occurs in the postpartum period. Furthermore, there are very few reports of it after cesarean section delivery. A 35-year-old woman presented with dyspnea and abdominal distension on the third day after cesarean section delivery. Under a suspicion of acute pancreatitis, she was initially managed with conservative treatment. However, she developed intraabdominal fluid collections and gastric bleeding, which were managed with percutaneous drainage, endoscopic hemostasis, and angiographic embolization. She was discharged with good clinical recovery. Postpartum pancreatitis, especially after cesarean section, is rare; however, its management is not different from that for usual pancreatitis.

Keywords: Pancreatitis, Postpartum period, Cesarean section, Gastric varix, Stomach ulcer

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Fig. 1.

CT reveals pancreatic swelling and abdominal fluid collection. (A) On axial CT scan, diffuse pancreatic swelling and slightly reduced parenchymal attenuation are seen, but no indication of pancreatic necrosis or duct dilatation. (B) On coronal CT scan, the peripancreatic area, retroperitoneal space, mesentery, and transverse mesocolon fluid collections are seen. In the omentum, mesentery, and peritoneum, diffuse infiltration is seen. (C) On axial CT scan, a small stone is seen in the gallbladder.

Fig. 2.

CT of the abdomen reveals a considerable amount of fluid. On coronal CT scan, considerable fluid collection is seen in the peritoneal cavity and retroperitoneum. Accumulation of contrast enhancement is seen in the wall of the fluid collections, in keeping with tissue reaction and abscess formation.

Fig. 3.

(A) An exposed vessel is present in the high body greater curvature anterior wall side. (B) Successfully installed hemoclips are shown.(C) Splenic vein obliteration (white arrow) is suspected on CT scan. (D) Histoacryl injection to the gastric varix is seen on the posterior wall side of the high body greater curvature. (E) Locations of posterior gastric artery pseudoaneurysm (black arrow) and left gastric artery angiographic embolization sites are shown.

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