P1906 - A Case of Hemorrhagic Pancreatitis: An Unusual Complication of HELLP Syndrome

Shahryar Khan, MD¹, Hamza Asif, MD², Mashal Alam Khan, MBBS³, Ahmad Khan, MBBS⁴, Aamer Ahmad, MBBS^5
1University of Kansas, Overland Park, KS; ²Khyber Teaching Hospital, Peshawar, North-West Frontier, Pakistan; ³Khyber Medical University, Overland Park, KS; ⁴Khyber Teaching Hospital, Nowshera, North-West Frontier, Pakistan; ⁵Khyber Medical University, Peshawar, North-West Frontier, Pakistan

Introduction: HELLP syndrome is a significant consequence on the preeclampsia spectrum associated with Hemolysis, increased liver enzymes, and low platelets. Any organ system may be the focus of the systemic vascular insult seen in preeclampsia and HELLP syndrome, which frequently leads to less common consequences. Rarely, a patient experiencing systemic vascular insult may get acute colitis, acute pancreatitis, and acute renal failure. These severe side effects, however rare, bear witness to the 1.1% death rate linked to HELLP syndrome. We report a case of postpartum HELLP syndrome associated with hemorrhagic pancreatitis.

Case Description/Methods: A 36-year-old female with a history of gestational diabetes presented to hospital with decreased fetal movements, labs consistent with abnormal liver enzymes, coagulopathy, and acute kidney injury. She underwent cesarean birth due to breech presentation and concern for HELLP syndrome. Postpartum, she had progressive worsening of liver enzymes, and renal functions. She had CT abdomen pelvis which showed hemorrhagic pancreatitis with diffuse peritoneal and extraperitoneal edema (Fig.1). Her mentation and respiratory status worsened, she was eventually transferred to ICU for intubation and requiring CRRT. She was started on PLEX therapy due to severe coagulopathies and multiorgan failure. Due to worsening abdominal distension, and peripancreatic fluid collection, percutaneous drain was placed. Fluid analysis from the drain showed elevated amylase and lipase. Interventional GI was consulted for concern of PD leak and ERCP was done with pigtail pancreatic stent along with retention flange. Her hospital course was complicated with candida peritonitis, acute parvovirus status post IVIG, and critical illness myopathy. The multidisciplinary team was involved in her care and was discharged to an acute rehab facility.

Discussion: This case highlights the rare complication of HELLP syndrome with hemorrhagic pancreatitis and prolonged hospital stay. This case report contributes to a small number of documented cases, where PLEX therapy was given due to lack of response to supportive therapy and may be effective in patients with severe disease. There is no prospective study regarding PLEX therapy and its effect in complications of HELLP syndrome like our case.



Disclosures:


Shahryar Khan, MD¹, Hamza Asif, MD², Mashal Alam Khan, MBBS³, Ahmad Khan, MBBS⁴, Aamer Ahmad, MBBS⁵. P1906 - A Case of Hemorrhagic Pancreatitis: An Unusual Complication of HELLP Syndrome, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.