{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:39:54Z","timestamp":1760060394087,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>During pregnancy and in the postpartum period, several diseases may arise or become exacerbated. Acute pancreatitis incidence during pregnancy is similar to the general population but increases in the first two years after delivery. This case report describes the evolution of necrotizing acute pancreatitis in a 30-year-old woman five months postpartum, with an atypical debut of acute pancreatitis, where the high levels of triglycerides caused by hormonal changes in the late postpartum period overlapped with an underlying hyperlipemia. Despite aggressive, multidisciplinary care, including surgical necrosectomy, continuous renal replacement therapy (CRRT), protective ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO), the prognosis was influenced by the hormonal changes both secondary to hypothalamic\u2013pituitary\u2013adrenal dysregulation and the postpartum hormonal changes, leading to an altered inflammatory response, evolution to MODS, ultimately resulting in death. The case highlights the complex interplay between postpartum immune and hormonal changes and the systemic inflammatory response of pancreatitis, emphasizing the critical need for postpartum-specific guidelines in managing acute pancreatitis, particularly regarding early risk stratification in order to prevent this pathology and its complications.<\/jats:p>","DOI":"10.3390\/life15091347","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T10:35:17Z","timestamp":1756204517000},"page":"1347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Too Late to Reverse: An Atypical Postpartum Case of Acute Necrotizing Pancreatitis with Refractory ARDS Despite ECMO Support"],"prefix":"10.3390","volume":"15","author":[{"given":"Mihaly","family":"Veres","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palad University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Intensive Care, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanziana","family":"Flamind Oltean","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, County Emergency Clinical Hospital of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sorin","family":"Pascanu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9666-0862","authenticated-orcid":false,"given":"Mihaela","family":"Butiulca","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oana Elena","family":"Branea","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra Elena","family":"Lazar","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca Liana","family":"Grigorescu","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Maringhini, A., Rossi, M., Patti, R., Maringhini, M., and Vassallo, V. 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