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

## TL;DR

A rare case of postpartum acute pancreatitis leading to septic shock is reported, highlighting the importance of early diagnosis and multidisciplinary treatment.

## Contribution

This case report adds to the limited literature on postpartum acute pancreatitis and its severe complication, septic shock.

## Key findings

- Biliary obstruction due to gallstones and biliary sludge was identified as the cause of postpartum acute pancreatitis.
- ERCP and cholecystectomy were effective in treating the condition despite the controversy surrounding ERCP in septic patients.
- Prompt diagnosis and multidisciplinary management are crucial to prevent fatal outcomes in postpartum acute pancreatitis.

## Abstract

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.

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.

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.

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.