Am J Perinatol 2008; 25(8): 469-471
DOI: 10.1055/s-0028-1085065
© Thieme Medical Publishers

Hypoxic Hepatitis in a Pregnant Patient: A Complication of Gastric Bypass Surgery

Nicole Kummer1 , Michael Cackovic1 , Michael Paidas1 , Edmund Funai1
  • 1Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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Publikationsverlauf

Publikationsdatum:
28. August 2008 (online)

ABSTRACT

Elevated serum transaminase levels can have many different etiologies, especially in the pregnant patient. Hypoxic hepatitis is a distinct syndrome caused by decreased hepatic blood flow that presents with a marked, but transient, increase in liver enzymes. A 28-year-old woman, gravida 3, para 2 with history of gastric bypass, presented in the second trimester with bright red blood per rectum, syncope, and epigastric pain. Laboratory studies were significant for anemia, elevated liver enzymes, and low platelets, raising concern for hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) and the need for emergent delivery. Complete evaluation included an upper endoscopy, which revealed a bleeding jejunal ulcer that was subsequently cauterized. Shortly after cauterization, the patient's laboratory values normalized and her pain resolved. Diagnosis of hypoxic hepatitis was made after exclusion of other liver-toxic entities, thus preventing delivery of a preterm infant. Hypoxic hepatitis may masquerade as other clinical syndromes, especially in the pregnant patient. Meticulous physical examination and assessment of laboratory values is essential for making a proper diagnosis and guiding management.

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Dr. Nicole E Kummer

Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University

333 Cedar St. P.O. Box 208063, New Haven, CT 06520

eMail: nicole.kummer@yale.edu