Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 627890, 5 pages doi:10.1155/2012/627890 Case Report Acute Pancreatitis Secondary to Gestational Hypertriglyceridaemia Alexis M. Cahalane, Myles J. Smith, James Ryan, and Donal Maguire Department of Hepatobiliary Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Correspondence should be addressed to Alexis M. Cahalane, alexiscahalane@yahoo.co.uk Received 14 April 2012; Revised 11 June 2012; Accepted 14 June 2012 Academic Editor: Tobias Keck Copyright © 2012 Alexis M. Cahalane et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gestational hypertriglyceridaemia is a rare cause of acute pancreatitis. Its pathophysiology is incompletely understood. Severity scoring and eﬀective management remain challenging. We report a case of acute pancreatitis secondary to gestational hyper- triglyceridaemia. We describe the use of computed tomography to provide an alternative determination of severity, as well as plasmapheresis as a means of treating the condition. 1. Introduction Gestational hypertriglyceridaemia (HTG) is a rare cause of acute pancreatitis [1, 2]. The pathophysiology of gestational HTG is attributed to the changing hormonal environment of pregnancy [3], although how this manifests as acute pancre- atitis remains to be fully elucidated [4]. A key component in the management approach to acute pancreatitis is the assessment of severity [5]. In this case, given the lipaemic nature of the patient’s blood, it was not possible to utilize the more conventional acute pancreatitis scoring schemes. This paper details the use of computed tomography as a means of assessing severity [6], as well as plasmapheresis as a treatment modality to optimise clinical outcome. 2. Clinical Case A 30-year-old, gravida 1 lady, of 39 weeks’ gestation, pre- sented to an outside hospital with acute severe epigastric pain, shoulder-tip pain, and severe intravascular volume depletion. An emergency lower section caesarian section was performed, and a healthy female was delivered. During the procedure, the blood was noted to be of “strawberry milkshake” consistency. Blood drawn for analysis precipi- tated into two layers. The upper two-thirds of the sample, constituting the plasma component, was lipid in nature. The laboratory was initially unable to process the sample, although an amylase of 900 U/L was obtained (reference range: 28–100 U/L). The patient had no signiﬁcant med- ical or family history, and her pregnancy was previously uncomplicated. A clinical diagnosis of acute pancreatitis was made based on the revised Atlanta Classiﬁcation of Acute Pancreatitis [7], most likely secondary to extreme gestational HTG, and the patient was transferred to our institution one day after caesarian section. Initial examination following transfer revealed a mark- edly unwell and tachycardic (140BPM) patient with gross abdominal distension and a rigid, tender abdomen. Further investigations demonstrated a leukocytosis (20.5 × 109/L, reference: 3.5–11 × 109/L), elevated random cholesterol (Chol, 20.3 mmol/L, reference: desirable <5.2 mmol/L) and triglyceride (TG, 45.29 mmol/L, reference: 0.15– 1.8 mmol/L) levels, and a prothrombin time (PT) of 20 seconds. Lipase (148 U/L, reference: 13–60 U/L), amylase (495 U/L), and C-reactive protein (CRP, 420.0 mg/L, ref- erence: 0–5.0 mg/L) were all elevated. Given the high lipid content of the patient’s blood at initial presentation, neither the Ranson or Glasgow scoring systems could be utilised. A contrast-enhanced CT abdomen and pelvis was performed, which found moderate volumes of ascites, small bowel