Extensive Arterial Thrombosis Complicating Acute Pancreatitis: A Case Report and Literature Review

Arterial thrombosis is a rare but potentially life-threatening complication of acute pancreatitis, with poorly defined clinical characteristics. This paper presents a case of extensive large-artery thrombosis complicating acute interstitial edematous pancreatitis along with a literature review. A 61-year-old man with acute interstitial edematous pancreatitis superimposed on chronic pancreatitis underwent contrast-enhanced computed tomography four weeks after the initial presentation because of persistent dyspepsia. The imaging revealed pancreatic pseudocysts and extensive arterial thrombosis involving the thoracic and abdominal aorta, bilateral internal iliac arteries, and the left subclavian artery. The patient was treated with systemic anticoagulation, resulting in radiologic resolution. A literature review identified 11 previously reported cases of acute pancreatitis-associated arterial thrombosis. Including the present case (n=12), five cases occurred in interstitial edematous pancreatitis, while seven developed in acute necrotizing pancreatitis. The aorta and major visceral arteries were the most frequently involved vessels. Arterial thrombosis was detected within the first week in seven cases, whereas five cases were diagnosed later, including one as late as 60 days. Arterial thrombosis can occur in necrotizing and interstitial pancreatitis and may present either early or later in the disease course. Awareness and timely imaging may facilitate prompt recognition and management.