The Strategic Management of Infected Pancreatic Pseudocyst in the Postpartum Period After Cesarean Delivery in a Pregnancy Complicated by Preeclampsia/Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome and Shock.

Pancreatitis is a rare but serious condition in obstetric patients, associated with significant morbidity and mortality. It can range from mild acute pancreatitis to severe complications such as necrosis, abscesses, pseudocysts, and multi-organ failure. While hypertriglyceridemia is a common cause, pancreatitis has also been linked to preeclampsia and shock. We present the case of a 22-year-old primigravida who developed an infected pancreatic pseudocyst 27 days after a cesarean section performed at 35 + 1 weeks of gestation due to preeclampsia/hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, complicated by disseminated intravascular coagulation (DIC) and shock. Initial CT scans revealed a large pseudocyst, which was managed conservatively with antibiotics and ultrasound-guided drainage. On the 46th postoperative day, the patient underwent a retroperitoneal incision and drainage. She was discharged three days after the procedure, and a follow-up two weeks later showed complete recovery and healing of the drainage wound. The current literature lacks established treatment guidelines for managing pancreatitis and its complications in obstetric patients. Based on this case and a review of previous reports, we recommend an approach that starts with conservative management, followed by minimally invasive procedures if necessary, for treating infected pancreatic pseudocysts in the postpartum period. Given that patients are already recovering from the stresses of pregnancy and delivery, avoiding highly invasive techniques that require additional anesthesia or surgery can help minimize stress and improve overall well-being.