Severe hyperlipemic pancreatitis in pregnancy. A case report.

Acute pancreatitis is an inflammatory disease due to going out of pancreated activated enzymes from the ductal system. This disease is characterized by elevation of the pancreatic enzymes in the serum and in the urines that evolves to a destruction more or less diffused of the gland. The factors that could cause an acute pancreatitis are different. Acute pancreatitis in pregnancy is rare. Its incidence is about 1/4000 and there is a very high mortality both for the mother (21%) and for the fetus (20%). In pregnancy the most frequent cause of acute pancreatitis is certainly hyperlipidemia (56%), the other frequent cause is lithiasis (37.5%). A negative factor is the physiological gestational hyperlipemia, in fact in this period the levels of cholesterol and triglycerides increase of the 23% and 53% respectively. The clinical picture is habitually dominated from intense ephigastric abdominal pain radiated to the back, nausea and vomit. These sympotoms join with a cleare increase of urinary and serum of amylases, and with a strong leucocitosis, with a reduction of the calcemia and of the magnesemia. A woman of 38 years old with a pregnancy at risk came in our Department in January 2002, at 12° weeks of gestation. In her first pregnancy she was submitted to a caesarean section urgently, on account of acute pancreatitis at 35% weeks of gestational age. The fetus was born dead and during the same procedure the woman was subjected to a pancreatic necrosectomy and profilattic colecistectomy, She was affected by a familiar hypertriglyceridemia IV-V joint with a partil reduction in lipoprotein lipase activity due to a mutation in the LPL gene. To study the patient by multidisciplinary approach she was submitted to surgical, diabetologic and medical advice. Her therapy was a combination of diet therapy, nutritional support with medium chain triglycerides and well planned preterm caesarean delivery. We believe that this combination therapy is an effective measure to prevent gestational hyperlipemic pancreatitis and leads to successful childbirth.