Pediatric Postpartum Gallstone Pancreatitis: A Case Study

Abstract

Background Hospitalizations in the United States for biliary tract pathology, mainly gallstone disease, affect 0.5% of peripartum and postpartum patients. Complications include significant disability, preterm delivery, and time away from the newborn due to surgery. Symptoms of gallstone pancreatitis are often dismissed as normal peripartum symptoms.

Case Presentation A 12-year-old female, 2 months postpartum, presented with 1 day of epigastric pain and vomiting. Labs showed elevated lipase (>2000). Computed Tomography (CT) showed acute pancreatitis, and choledocholithiasis was noted on ultrasound (US). She underwent endoscopic retrograde cholangiopancreatography, followed by laparoscopic cholecystectomy. Review of records revealed 3 previous visits for vomiting and abdominal pain. Gallstones were not suspected due to missed follow-up or suspicion of pregnancy-related diagnoses. Social history was complex due to immigration and socioeconomic status (SES). A 17-year-old female presented similarly, at 2 months postpartum, with epigastric pain. She was discharged with a presumed urinary tract infection. Later diagnostic tests revealed acute pancreatitis (CT) and gallstones (US). After treatment, lipase remained elevated (>6000), but other labs suggested passage of the previously obstructing gallstone. She underwent laparoscopic cholecystectomy. Care was delayed due to insurance barriers.

Conclusion Patients <20 years are at greatest risk for postpartum gallstone pathology. This differential should be prioritized in young patients with epigastric or right upper quadrant pain, especially in the presence of risk factors such as low SES.

Clinical significance It is typical for gallstone acute pancreatitis to have symptoms prior to presentation, but it is unclear if preceding symptoms in postpartum patients are misdiagnosed and attributed to pregnancy, or if acute presentation is more common. Increased awareness about gallstones in postpartum pediatric patients can mitigate the dangerous sequelae of gallstones including acute pancreatitis.