Chylothorax as a rare complication of acute pancreatitis in a 25-year-old woman after cesarean section

• Main Authors: Anna Smędra, Maciej Barzdo, Justyna Krupińska, Joanna Klemm, Waldemar Machała, Stefan Szram, Jarosław Berent
• Format: Article
• Language: English
• Published: Termedia Publishing House 2016-03-01
• Series: Archives of Forensic Medicine and Criminology
• Subjects: chylothorax; cesarean section; acute pancreatitis; complication; appropriateness of medical management
• Online Access: http://www.termedia.pl/Chylothorax-as-a-rare-complication-of-acute-pancreatitis-in-a-25-year-old-woman-after-cesarean-section,82,27115,1,1.html
• ISSN: 0324-8267; 1689-1716

The paper presents the case of a 25-year-old woman who underwent cesarean section for gynecological indications in the 37th week of her second pregnancy. The perioperative course was uncomplicated, but one day later the general condition of the patient suddenly deteriorated: she developed respiratory disorders requiring intubation and treatment in an intensive care unit. On the 6th day after the surgery, the patient was diagnosed with acute pancreatitis. Appropriate conservative treatment was instituted, resulting in a gradual improvement of her condition. On the 13th postoperative day, a cardiac arrest in asystole occurred, with no response to the undertaken resuscitation procedures. An autopsy performed in the Department of Forensic Medicine in Łódź revealed, among other findings, acute pancreatitis with enzymatic necrosis of the adipose tissue, a significant accumulation of lymph in both pleural cavities, and pulmonary atelectasis. As demonstrated by the analysis of the case, chylothorax had most probably developed in the course of acute pancreatitis which was a complication of the cesarean section. Consequently, the prosecutor opened an investigation into the case under Article 155 of the Polish Penal Code to assess the appropriateness of medical management. The medico-legal opinion was issued by experts from outside the Department of Forensic Medicine in Łódź. In their view, the medical management of the patient was correct.