Postpartum acute pancreatitis in the setting of severe preeclampsia: Diagnostic challenges and surgical findings

Introduction: Acute pancreatitis is a rare complication of pregnancy; however, it can be associated with significant maternal and fetal mortality. Suggestive symptoms mimic multiple pregnancy and postpartum conditions, making the diagnosis difficult. This case report highlights diagnostic challenges and imaging findings in a patient with severe preeclampsia whose postpartum course was complicated by acute pancreatitis. Case Report: A reproductive-aged patient presented, in the late second trimester, for preeclampsia with severe features by blood pressure and creatinine. Worsening of maternal kidney function and fetal status required urgent cesarean delivery. The postoperative course was complicated by severe abdominal pain. On initial imaging, there was postoperative fluid without any significant intra-abdominal pathology. However, worsening of the clinical condition and development of an acute abdomen required an exploratory laparotomy. Intraoperative findings were significant for intra-abdominal ascites and extensive saponification of the omentum, concerning for acute pancreatitis. Testing of the ascitic fluid revealed an elevated lipase level at 5,319 U/L, and a retrospective serum lipase level was 2,109 U/L. Despite a normal appearance of the pancreas on computed tomography (CT) scan of the abdomen, laboratory findings were confirmatory of the diagnosis of acute pancreatitis. The patient then underwent multiple abdominal explorations with direct peritoneal resuscitation. Recovery was progressive and discharge occurred three weeks postpartum. Conclusion: Although rare, acute pancreatitis can complicate the postpartum course, especially in the setting of severe preeclampsia. This case underscores diagnostic challenges due to overlapping presentations. It is important to keep a high index of suspicion for acute pancreatitis in the differentials of postpartum abdominal pain, as late recognition and management are associated with significant morbidity.