Recurrent acute lithiasic pancreatitis in the late puerperium without index cholecystectomy: a case report
DOI:
https://doi.org/10.5281/zenodo.21909571Keywords:
acute pancreatitis, recurrence, cholelithiasis, cholecystectomy, postpartum period, case reportAbstract
Objective: To describe a case of recurrent acute lithiasic pancreatitis in the late puerperium, focusing on factors that delayed cholecystectomy.
Methods: We present the case of a 34-year-old woman from inland Paraguay, in late puerperium (2 months), with irregularly treated arterial hypertension, who had two episodes of right-upper-quadrant pain radiating to the back, with vomiting, 15 days apart.
Results: In the first episode, laboratory tests showed marked lipase and amylase elevation, elevated transaminases and total bilirubin of predominantly indirect type; abdominal ultrasound showed hepatic steatosis, multiple gallstones, a common bile duct dilated to 11 mm and free abdominal fluid. Acute lithiasic pancreatitis was diagnosed and managed with parenteral hydration and analgesia, without cholecystectomy during that admission. Fifteen days after discharge she was readmitted with similar symptoms; repeat ultrasound showed gallbladder wall thickening, pericholecystic fluid and confirmed cholelithiasis, with renewed amylase elevation. After confirmed recurrence, combined medical and surgical management was chosen and cholecystectomy was scheduled to address the underlying lithiasic cause.
Conclusion: This case illustrates how lack of cholecystectomy during the index admission for acute lithiasic pancreatitis, influenced by limited access to care inland, was associated with early disease recurrence, and underscores the importance of timely cholecystectomy to prevent recurrent biliary pancreatitis.
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