1
|
Cao W, Ni X, Gan M, Xie B, Xie Y, Wang Q, Meng L, He C, Chen J, Wang X. Treatment and diagnosis of hyperlipidemia acute pancreatitis in pregnancy associated with pre‑pregnancy obesity and diabetes: A case report. Exp Ther Med 2023; 26:573. [PMID: 38023361 PMCID: PMC10652241 DOI: 10.3892/etm.2023.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Hyperlipidemia acute pancreatitis (HLAP) is a specific type of pancreatitis mainly caused by elevated serum triglyceride (TG) levels. Therefore, knowledge of patients' medical history is crucial to the identification of those at high risk of HLAP. Diabetes and obesity are associated with high levels of triglycerides, a risk factor for the development of HLAP, which should be controlled before pregnancy. Moreover, HLAP is associated with additional diagnostic and management challenges related to hyperlipidemia (HL) and pregnancy. HLAP during pregnancy has a rapid onset and rapid progression, and complications are more likely to damage the function of multiple organs. HLAP is more common after 28 weeks of pregnancy, the cause is mostly high TG and the serum TG of the patient is often >1,000 mg/d1. Clinicians should be alert to the occurrence of server acute pancreatitis (AP). Therefore, clinicians need to identify and implement effective treatment in a timely manner to control the progression of HLAP during pregnancy and improve pregnancy outcomes. The present study reported the case of a 26-year-old pregnant patient who was hospitalized for epigastric pain at 35 weeks and 2 days of gestation. Medical and family history reported previous diagnoses of diabetes and obesity (weight before pregnancy, 103 kg; BMI, 36.40 kg/m2). Laboratory tests demonstrated high levels of lipase and amylase, a notable systemic inflammatory response, HL, coagulopathy, hypoproteinemia and hyperglycemia. Abdominal ultrasonography demonstrated a hypoechoic pancreatic head. A clinical diagnosis of AP was confirmed using CT scanning. Initial interventions for HLAP included aggressive intravenous hydration, bowel rest, pain control and a combination of heparin and insulin. Lipid-lowering agents were administered to reduce serum lipid levels. Hemoperfusion and continuous renal replacement therapy were also used to rapidly counteract the elevated lipid levels. Antibiotics were administered in the present case because inflammatory markers such as leukocytes, neutrophils and C-reactive protein were elevated. The patient and newborn were discharged 11 days after hospitalization, with an improvement in maternal clinical health and the infant was healthy. When evaluating pregnant patients with pre-obesity and diabetes presenting with abdominal pain, obstetricians should consider HLAP. Timely diagnosis and multi-team precision treatment are effective for good outcomes for mother and baby.
Collapse
Affiliation(s)
- Weiping Cao
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Xia Ni
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Mengwen Gan
- Department of Nursing, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Bing Xie
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Yurong Xie
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Qin Wang
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Lishi Meng
- Department of Computed Tomography, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Chao He
- Central Laboratory of Medicine, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Juan Chen
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
- Department of Obstetrics, Shanghai Changning District Maternal and Children Health Hospital, Shanghai 200050, P.R. China
| | - Xinzhi Wang
- New Drug Screening Center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu 210009, P.R. China
| |
Collapse
|
2
|
Zhu HD, Shen W, Wu HL, Sang X, Chen Y, Geng LS, Zhou T. Postpartum ovarian vein thrombosis after cesarean section and vaginal delivery: Two case reports. World J Clin Cases 2023; 11:3877-3884. [PMID: 37383122 PMCID: PMC10294170 DOI: 10.12998/wjcc.v11.i16.3877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Postpartum ovarian vein thrombosis (POVT) is a rare puerperal complication. It is easily missed or misdiagnosed due to its insidious onset and lack of specific clinical symptoms and signs. This paper reports two patients who developed right ovarian vein thrombosis after cesarean section and vaginal delivery, respectively.
CASE SUMMARY Case 1 was a 32-year-old female who underwent a cesarean section in labor at 40 wk of gestation due to fetal distress. The patient was persistently febrile after the operation and escalated antibiotic treatment was ineffective. POVT was diagnosed by abdominal computed tomography (CT) and was treated by increasing the dose of low molecular weight heparin (LMWH). Case 2 was a 21-year-old female with a spontaneous vaginal delivery at 39 wk of gestation. The patient developed fever and abdominal pain 3 days after delivery. POVT was promptly identified by abdominal CT, and the condition was quickly controlled after treatment with LMWH and antibiotics.
CONCLUSION These two cases occurred after cesarean section and vaginal delivery, respectively. The diagnosis was mainly based on imaging examination due to the unspecific clinical symptoms and signs, the CT scan provided an especially high diagnostic value. Comparing these two cases, escalating antibiotics alone did not provide significant therapeutic benefit, but the early escalation of anticoagulant dosage seemed to shorten the disease course. Therefore, early diagnosis by CT followed by aggressive anticoagulation might have a positive effect on improving the prognosis of the disease.
Collapse
Affiliation(s)
- Hong-Dan Zhu
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Wei Shen
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - He-Li Wu
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Xia Sang
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Yun Chen
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Li-Shu Geng
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Tao Zhou
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| |
Collapse
|
3
|
Wang JJ, Hui CC, Ji YD, Xu W. Computed tomography diagnosed left ovarian venous thrombophlebitis after vaginal delivery: A case report. World J Clin Cases 2023; 11:896-902. [PMID: 36818636 PMCID: PMC9928707 DOI: 10.12998/wjcc.v11.i4.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postpartum ovarian vein thrombophlebitis (POVT) is a rare but serious postpartum complication that affects mostly postpartum women. A high index of suspicion is required when faced with sudden postpartum abdominal pain.
CASE SUMMARY A 25-year-old healthy woman who accepted a vaginal delivery procedure suffered fever (temperature 39.6℃) one day after delivery, accompanied with left lower abdominal pain. Physical examination indicated mild tenderness in the left lower abdomen, accompanied with rebound pain. The patient was confirmed to have left ovarian venous thrombosis with inflammation after receiving a multi-detector row computed tomography scan.
CONCLUSION POVT is a rare and dangerous postpartum complication. A high index of suspicion is required for the occurrence of ovarian venous thrombosis when faced with postpartum abdominal pain and fever. Early application of Doppler ultrasound, computed tomography, magnetic resonance imaging and other auxiliary examinations is conducive to timely and accurate diagnosis of POVT, thus reducing maternal mortality.
Collapse
Affiliation(s)
- Jin-Jin Wang
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Chu-Chu Hui
- Department of Ultrasound, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Yi-Ding Ji
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Wei Xu
- Department of Emergency Medicine, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| |
Collapse
|
4
|
Jiang L, Liang WX, Yan Y, Wang SP, Dai L, Chen DJ. Thrombotic pulmonary embolism of inferior vena cava during caesarean section: A case report and review of the literature. World J Clin Cases 2022; 10:4226-4235. [PMID: 35665114 PMCID: PMC9131231 DOI: 10.12998/wjcc.v10.i13.4226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/21/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thrombotic pulmonary embolism (TPE) is one of the most critical diseases in obstetrics but is rarely reported in caesarean section (CS) because TPE patients in CS have a high risk of death and are difficult to diagnose. This case report of TPE during CS was recorded by transthoracic echocardiography (TTE) and can provide a reference for the differential diagnosis of critical illnesses in CS.
CASE SUMMARY A 37-year-old pregnant woman with rheumatic heart disease (RHD), gravida 5 and para 1 (G5P1), presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure, pulmonary hypertension and arrhythmia. After placental removal during CS, TTE revealed a nascent thrombus in the inferior vena cava (IVC) that elongated, detached and fragmented leading to acute thromboembolic events and acute TPE. This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient. This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment. This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.
CONCLUSION Pregnancy with heart failure could trigger inferior vena cava (IVC)-origin TPE during CS. Detection and timely treatment can avoid serious consequences.
Collapse
Affiliation(s)
- Lan Jiang
- Department of Medical Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Wei-Xiang Liang
- Department of Medical Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Yi Yan
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Shou-Ping Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510015, Guangdong Province, China
| | - Li Dai
- Department of Medical Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Dun-Jin Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510015, Guangdong Province, China
| |
Collapse
|
5
|
Song H, Men H, Song C, Feng H, Tan H, Zuo S. Low-molecular-weight heparin reduces the formation of lower limb deep venous thrombosis in patients with hypertensive intracerebral hemorrhage. Am J Transl Res 2021; 13:10509-10516. [PMID: 34650721 PMCID: PMC8507008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To demonstrate that low-molecular-weight heparin (LMWH) can reduce the formation of lower limb deep venous thrombosis (DVT) and improve the quality of life (QOL) of patients with hypertensive intracerebral hemorrhage (HICH). METHODS Totally, 98 patients with HICH were selected according to different treatment and intervention schemes. Patients receiving routine intracranial pressure reduction and blood pressure regulation intervention were included in group A (n=46) and those receiving LMWH calcium on the basis of treatment in group A were included in group B (n=52). The total effective rate of patients was compared between the two groups, and the prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP), D-dimer, and inflammatory factor levels as well as complications and QOL scores before and after treatment were recorded and compared. RESULTS The FDP and D-dimer showed an increasing trend in both groups after treatment, with the increase being significantly lower in group B than in group A (P<0.001). Serum tumor necrosis factor-α and interleukin-1β levels increased significantly in the two groups after treatment, with the increase being significantly lower in group B than in group A (P<0.05). Complications of pulmonary embolism, DVT, intracranial hemorrhage, and gastrointestinal hemorrhage were better in group B than in group A (P<0.05). In terms of QOL, physical and mental health, material life, and social functioning were significantly higher in patients of group B than for those in group A (P<0.001). CONCLUSIONS The application of LMWH in patients with HICH can reduce the formation of lower limb DVT.
Collapse
Affiliation(s)
- He Song
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Huanli Men
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Chunwang Song
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Hongwei Feng
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Haopeng Tan
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Shuhao Zuo
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| |
Collapse
|