Multidisciplinary Rescue for a Lethal Triad: Severe Hypertriglyceridemia, Necrotizing Pancreatitis, and Abdominal...

We report the multidisciplinary management of a life-threatening triad in a 30-year-old primigravida: severe hypertriglyceridemia (14,230 mg/dL) complicated by necrotizing pancreatitis, subsequent abdominal compartment syndrome, and multiorgan failure.

A primigravida at 38 weeks of gestation presented with epigastric pain, vomiting, and fever. Laboratory findings revealed marked hypertriglyceridemia (14,230 mg/dL) and elevated pancreatic enzymes (amylase 3,630 U/L, lipase 6,084 U/L), with imaging confirming necrotizing pancreatitis. An emergency cesarean section was performed for maternal stabilization, resulting in the delivery of a viable neonate. Postoperatively, the patient developed respiratory failure requiring intubation and abdominal compartment syndrome necessitating laparotomy, during which 4,000 mL of necrotic fluid was drained. With intensive multidisciplinary management, maternal stabilization was achieved after eight days in the intensive care unit, and neonatal outcomes were favorable.

This case highlights that severe hypertriglyceridemia during pregnancy can precipitate life-threatening maternal complications and jeopardize fetal well-being. Early multidisciplinary management, including prompt delivery when indicated and aggressive maternal support (e.g., plasmapheresis), is essential for optimizing perinatal outcomes.