Pulmonary Embolism: A Rare Presentation of Acute-on-Chronic Pancreatitis in Children

Although splanchnic vein thrombosis may manifest as pancreatitis, it is rare to find venous thrombosis at other body sites. We present a rare case of acute-on-chronic pancreatitis in a patient who subsequently developed a deep venous thrombosis (DVT) of the right lower limb and pulmonary embolism (PE). A 14-year-old male presented with an acute history of upper abdominal pain, vomiting, and abdominal distension. Workup for pancreatitis was normal except for low hemoglobin and high serum pancreatic enzymes. The CT abdomen favored a diagnosis of acute-on-chronic pancreatitis with dilated pancreatic duct, multiple pseudo-pancreatic cysts, and saddle pulmonary embolus. He was treated with medical conservative therapy. For DVT and saddle PE, he was started on enoxaparin, which was later switched to rivaroxaban. A CT angiogram after three months of therapy with rivaroxaban showed the complete disappearance of the clot. Early detection of such life-threatening complications is important to achieve favorable outcomes in these patients.