# Ischemic pancreatitis following uterine inversion and severe postpartum hemorrhage: A case report and review of the literature

## TL;DR

A rare case of ischemic pancreatitis following severe postpartum hemorrhage and cardiac arrest is reported, highlighting the importance of early diagnosis and multidisciplinary treatment.

## Contribution

This is the first detailed case report of ischemic pancreatitis caused by postpartum hemorrhage and cardiac arrest.

## Key findings

- Ischemic pancreatitis can occur as a complication of severe postpartum hemorrhage and cardiac arrest.
- Contrast-enhanced CT and multidisciplinary management are essential for diagnosis and treatment.
- The patient fully recovered after surgical drainage and intensive care.

## Abstract

Ischemic pancreatitis is a rare but potentially life-threatening condition typically associated with cardiovascular events, such as aortic dissection and cardiogenic shock. This report presents a unique case of ischemic pancreatitis following severe postpartum hemorrhage (PPH) and cardiac arrest caused by uterine inversion. A 34-year-old woman developed uterine inversion immediately after delivery, which resulted in massive hemorrhage and cardiac arrest. The patient was stabilized in the intensive care unit after successful resuscitation and uterine repositioning. On postpartum day 5, the patient developed fever and hypotension. On postpartum day 9, contrast-enhanced computed tomography (CT) revealed pancreatic enlargement and peripancreatic fluid collection consistent with acute pancreatitis. The absence of common etiologies, such as alcohol use, gallstones, or hypertriglyceridemia, along with a clear temporal relationship between hemorrhagic shock and cardiac arrest, strongly supported a diagnosis of ischemic pancreatitis. Despite initial conservative treatment and endoscopic drainage, the persistent fever necessitated open surgical drainage. The patient recovered completely and was discharged on postpartum day 89. This appears to be the first case report to provide a detailed description of the clinical course and a therapeutic strategy for ischemic pancreatitis following PPH. Clinicians should recognize that ischemic pancreatitis may develop as a secondary complication in patients with PPH complicated by cardiac arrest. If pancreatitis is suspected, prompt contrast-enhanced CT and timely multidisciplinary management are essential to achieve an accurate diagnosis and initiate effective treatment.

•This appears to be the first detailed report of ischemic pancreatitis secondary to postpartum hemorrhage.•Cardiac arrest with postpartum hemorrhage may trigger ischemic pancreatitis.•Computed tomography for diagnosis and multidisciplinary treatment are crucial for clinical management.

This appears to be the first detailed report of ischemic pancreatitis secondary to postpartum hemorrhage.

Cardiac arrest with postpartum hemorrhage may trigger ischemic pancreatitis.

Computed tomography for diagnosis and multidisciplinary treatment are crucial for clinical management.