Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report

Abstract

Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.

Second‐trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report

“…AFLP usually manifests during late third trimester at a mean of 36 weeks, 1,5 and up to 9.8% in the immediate postpartum period 26 . Nonetheless, several cases were identified during second trimester, 6,18,27–33 but interestingly, it has never been reported in first trimester 2 . Potential clinical risk factors include prior episode of AFLP in a previous pregnancy, 34 multiple gestations, 35 underweight (BMI of ≤20), 3 nulliparity 8 and carrying a male fetus 36 .…”

“…A search was performed in the PubMed and Google Scholar database for cases contracting AFLP before third trimester. We could identify nine compatible cases published in the English language with complete account of details (beside current case) 6,18,27–33 . Cases that were reported as a part of case series but lacking detailed description of individual patients were hence excluded from this review 3,26 (Table 1).…”

Acute Fatty Liver of Pregnancy

“…9,12 Fatty acid metabolites are toxic to pancreatic tissue and likely play a role in the etiology of acute fatty liver of pregnancyassociated pancreatitis. 5,22 Placental dysfunction may stem from increased fatty acids within the placenta itself, resulting in impaired oxygen delivery to the fetus. 23 Fibrin deposition in the chorionic villi may also result in placental hypoperfusion and hypoxic damage to the fetus.…”

“…63,64 Pancreatitis may be present and can be complicated by pseudocysts with secondary infections, hemorrhagic pancreatitis, and necrotizing pancreatitis. 5,11,16,22,57 Pancreatitis typically develops after the onset of renal and hepatic dysfunction. Some experts suggest following serum markers including lipase and amylase for several days after the onset of illness and maintaining a low threshold to perform imaging if abnormal.…”

Role of 3-Hydroxy Fatty Acid-Induced Hepatic Lipotoxicity in Acute Fatty Liver of Pregnancy

“…AFLP is also associated with the development of pancreatitis [ 108 , 109 , 110 , 111 , 112 , 113 , 114 ]. The role of 3-hydroxy fatty acids in relation to the development of pancreatitis remains unexplored.…”