Association between Severe SARS-CoV-2 Infection and Severe Acute Pancreatitis in Pregnancy and Postpartum

Abstract

Introduction: SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited to it. The gastrointestinal symptoms are polymorphic, including diarrhea, vomiting, abdominal pain, and even acute pancreatitis (AP). Pregnant women are more vulnerable to SARS-CoV-2 infection and have a higher risk of severe outcomes of COVID-19.

Case report: We present a case report of a 31-year-old primigravid patient at 30 weeks of gestation, unvaccinated, with a medical history of thrombophilia, chronic nephropathy of unknown origin, hypertension, and optic neuropathy with left eye hemianopsia. She was diagnosed with moderate-to-severe COVID-19 and respiratory failure, with indication for cesarean section. Postpartum, she developed severe acute pancreatitis, complicated by peripancreatic and supradiaphragmatic abscesses. After 3 months of hospitalization and eight surgical interventions, the patient was discharged. A short mini-review of the literature is introduced.

Conclusion: Pregnant women with cardiovascular comorbidities are prone to severe complications of SARS-CoV-2 infection. Clinicians should be aware of the association of SARS-CoV-2 and AP in pregnant women.

Keywords: COVID-19; acute pancreatitis; pregnancy; retroperitoneal necrosis.

Figure 1

Event timeline from admission to hospital to discharge from intensive care. CT: computer tomography; Abdo: abdominal; Thor: thoracic; AP: acute pancreatitis; US: ultrasound; NIV: noninvasive ventilation; iMV: invasive mechanical ventilation; CRRT: continuous renal replacement therapy; BZD: benzodiazepines; orange represents clinical presentation; green represents lab and imaging investigations; blue represents therapy.

Figure 2

Thoracic CT scan. (A) Native thoracic scan showing bilateral COVID-19 pneumonia, affecting 30% of the lungs, and minimal right pleural effusion. (B) Contrast-enhanced thoracic CT scan revealing medium right pleural effusion and bilateral COVID-19 pneumonia. (C,D) Native thoracic CT scan, transversal view with bilateral pleural effusions and bacterial pneumonia. (E,F) Native thoracic CT scan, sagittal view with large right pleural effusion, inferior right lobe atelectasis, and bacterial pneumonia.

Figure 3

Abdominal CT scan in evolution. (A) Initial contrast-enhanced CT scan showing diffuse pancreatic edema and peripancreatic liquid collection. (B) Native CT scan revealing inhomogeneous pancreas characteristic of necrotizing pancreatitis, peripancreatic and retroperitoneal collection, and moderate ascites.

Figure 4

Abdominal and thoracic ultrasound in evolution. (A,B): Peritoneal effusion with septa. (C):Perisplenic cloasonated peritoneal effusion. (D): Pleural effusion of the inferior lung lobe, with air bronchograms. (E,F): Left subphrenic effusion, showing deep enhancement, suggestive of infection (abscess).