Septic shock caused by postpartum acute pancreatitis, a case report and literature review

Abstract

Introduction: Postpartum acute pancreatitis (PAP) is a rare but potentially life-threatening condition that can occur following childbirth. The incidence of PAP is estimated to be between 1 in 1,000 and 1 in 10,000 deliveries, with a significant proportion of cases linked to biliary causes, particularly gallstones and biliary sludge. Prompt diagnosis and comprehensive management are essential to prevent severe complications such as septic shock and peritonitis.

Case presentation: We report the case of a 25-year-old white woman who presented with severe abdominal pain and septic shock 18 days after a cesarean section. Initial management included aggressive fluid resuscitation, broad-spectrum antibiotics, and pain control. Diagnostic imaging and laboratory tests confirmed the presence of biliary obstruction due to gallstones and biliary sludge, leading to acute pancreatitis. An endoscopic retrograde cholangiopancreatography (ERCP) was performed to remove the biliary obstructions, followed by a laparoscopic cholecystectomy to prevent recurrence.

Discussion: PAP, while rare, poses significant risks and can lead to serious side effects such as septic shock. Early diagnosis by laboratory workup and imaging is essential. In this instance, gallstones and biliary sludge were found to be the culprit, requiring cholecystectomy and ERCP. ERCP was effective in this patient, despite its controversy in septic patients. The effective management of PAP requires a multidisciplinary approach involving obstetricians, gastroenterologists, surgeons, and critical care specialists.

Conclusion: PAP must be identified and treated as soon as possible. Bile obstruction is a common problem that necessitates prompt imaging and, if necessary, endoscopic or surgical intervention. Delays can be fatal; timing is crucial. To prevent deadly consequences, doctors must be extremely suspicious of postpartum patients presenting with abdominal pain.

Keywords: Biliary obstruction; Gallstones; Postpartum acute pancreatitis; Septic shock.

Fig. 1

A Anteroposterior (AP) abdominal X-ray showing extensive dilation of the small intestine and colon loops, with no evidence of air-fluid levels or gas in the rectum, suggesting ileus. B Supine abdominal X-ray further illustrates the extensive dilation of the bowel loops and absence of gas in the rectum, confirming the diagnosis of ileus

Fig. 2

Coronal CT scan of the abdomen showing biliary sludge, gallstones (indicated by the red arrow), and evidence of pancreatitis (indicated by the blue arrow)

Fig. 3

A An axial CT scan of the abdomen revealed gallstones (red arrow), evidence of pancreatitis (green arrow), and bowel dilation (blue arrows). B An axial CT scan of the abdomen showed extensive pancreatic inflammation (green arrows), additionally, (blue arrows) indicate bowel edema and peritoneal fluid accumulation, suggestive of peritonitis."