S3486 Management of Acute Pancreatitis Due To Hypertriglyceridemia in Pregnancy

Introduction: Acute pancreatitis has multiple etiologies, with hypertriglyceridemia being the third most common. The risk of pancreatitis increases with triglyceride levels exceeding 1000, with an incidence of 10%-20%. Hypertriglyceridemia-induced acute pancreatitis occasionally arises during the third trimester. We present a case of hypertriglyceridemia-induced acute pancreatitis in a patient with a newly discovered first-trimester intrauterine pregnancy. Case Description/Methods: A 35-year-old woman with Type-II diabetes mellitus presented to the ED with severe epigastric pain radiating to the back, nausea, and vomiting. Both the patient’s mother and twin sister had hypertriglyceridemia. The patient’s labs were remarkable for lipase >1800 and triglycerides of 3900 which rose to >5000 within 24 hours. Right upper quadrant ultrasound showed cholelithiasis without evidence of cholecystitis. Routine beta-hCG performed in the emergency department was incidentally positive and consistent with an intrauterine pregnancy at 5-week gestation, confirmed via ultrasound. Abdominal computed tomography demonstrated acute interstitial pancreatitis without necrosis, extensive peripancreatic fluid and infiltration, and fluid tracking into the pelvis. Plasmapheresis was considered due to the severity and risk to the pregnancy, but ultimately, the patient was treated supportively and improved clinically with bowel rest, insulin drip, fenofibrate, Niaspan, and Lovaza. Unfortunately, ultrasound prior to discharge showed no gestational sac and a drop in beta-hCG, representative of a miscarriage. Discussion: Pancreatitis in pregnancy is associated with high maternal morbidity rates and adverse fetal outcomes. While uncommon in the first trimester, the probable etiology for this patient’s clinical presentation is contributed by known diabetes and hypertriglyceridemia of likely familial origins, given the strong family history. Prompt treatment is necessary to prevent adverse maternal and fetal outcomes. Although this patient clinically improved with supportive care, plasmapheresis has been shown to be effective in preventing and treating hypertriglyceridemia-induced acute pancreatitis, thus also leading to improved outcomes for the developing fetus. In conclusion, patients with suspected familial hypertriglyceridemia should be counseled on triglyceride management before pregnancy to prevent this complication. Furthermore, in the event of developing hypertriglyceridemia-induced acute pancreatitis in pregnancy, plasmapheresis can be considered for treatment.