Hypertriglyceridemic pancreatitis in pregnancy: case reports and review of the literature
A 32-year-old Bangladeshi woman was seen urgently in outpatient clinic with an unplanned pregnancy of approximately six weeks’ gestation.\nShe had a past history of polycystic ovarian syndrome, non-alcoholic fatty liver disease, obesity and developed type 2 diabetes six years previously. She had been noted at diagnosis of diabetes to have mild hypertriglyceridemia (), which was thought to be due to uncontrolled diabetes. Over the preceding four years, she had suffered three bouts of acute pancreatitis. On the first admission, she was noted to have marked hypertriglyceridemia. Despite high doses of insulin, statin, fibrate, omega-3 fish oils, metformin and sitagliptin, her glycaemic control remained poor (glycated haemoglobin ranging from 9.4% [79 mmol/mol] to 11.8% [105 mmol/mol]) as did her lipid control, despite input from diabetes nurses, dietitian and an inpatient admission for stabilization of glucose levels. She admitted her dietary concordance was poor. She had two previous uneventful pregnancies prior to her diagnosis of diabetes, neither of which was complicated by gestational diabetes.\nShe was counselled about the high risk of pancreatitis in pregnancy, but remained keen to continue the pregnancy. Fibrate, insulin, metformin and fish oil therapy was continued as the risk of hypertriglyceridemia-induced pancreatitis was deemed significant. She was seen by a dietitian and booked into the diabetic pregnancy service for weekly review. Glycaemic control and lipid control remained suboptimal despite rapid titration in insulin doses.\nAt 12 weeks’ gestation, she was admitted with acute abdominal pain and vomiting. Abdominal examination showed peritonism. She was dehydrated, blood pressure 110/80 mmHg and pulse 120 regular. Serum amylase was elevated at 1464 (normal range <90 U/L). Arterial blood gases were normal. She was admitted to the High Dependency Unit and received supportive therapy with intravenous fluids, starvation and antibiotics, and made a rapid recovery within five days. Careful counselling of her risk of recurrent pancreatitis was discussed. The option to have frequent plasma exchange during pregnancy was offered, but after discussion with her family she opted for a medical termination of pregnancy, which she underwent at 14 weeks’ gestation. Contraceptive advice was given to eliminate the risk of unplanned pregnancy in the future.