Acute Pancreatitis-Associated Thrombotic Venopathy

Area of Science:

• Gastroenterology
• Vascular Medicine
• Critical Care Medicine

Background:

• Acute pancreatitis is a frequent cause of acute abdominal conditions, often leading to diverse local and systemic complications.
• Vascular complications associated with acute pancreatitis are frequently underreported in medical literature.
• Alcohol-induced acute pancreatitis can present with severe withdrawal syndrome, complicating patient management.

Observation:

• A 66-year-old male patient with alcohol-induced acute pancreatitis and severe ethanol withdrawal syndrome experienced early and extensive thrombotic events.
• The patient presented with concurrent thrombosis in the distal superior mesenteric vein, greater saphenous vein, and pulmonary embolism.
• This case represents a rare and intriguing multifocal presentation of venous thrombosis complicating acute pancreatitis.

Findings:

• The study highlights an atypical but clinically significant presentation of multifocal and early-onset venous thrombosis in a patient with acute pancreatitis.
• The patient's thrombotic events involved both splanchnic and peripheral vasculature, along with pulmonary embolism.
• Management included low-molecular-weight heparin due to the presence of pulmonary embolism and extremity vein thrombosis.

Implications:

• This case underscores the importance of recognizing and investigating vascular complications in acute pancreatitis, even when atypical.
• The optimal management strategy for splanchnic venous thrombosis in acute pancreatitis, particularly when combined with other thrombotic events, requires further investigation.
• Further research is necessary to establish clear guidelines for anticoagulation in patients with acute pancreatitis and concurrent venous thromboembolism.