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Inferior vena cava stenosis and pancreatic ascites complicating chronic calcific pancreatitis: a case report
V Wongpaitoon1, S Kurathong, P Pekanan
1Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
This case report details a rare instance of inferior vena cava obstruction caused by chronic calcific pancreatitis in a young Thai male. Treatment successfully resolved both the obstruction and pancreatic ascites.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Radiology
Background:
- Inferior vena cava (IVC) obstruction is a serious condition that can lead to significant morbidity.
- Chronic calcific pancreatitis is a progressive disease characterized by pancreatic calcifications and often associated with alcohol abuse or tropical factors.
- Pancreatic ascites, a rare complication of pancreatitis, results from leakage of pancreatic fluid into the peritoneal cavity.
Observation:
- A 19-year-old male presented with massive ascites, back pain, and leg edema, indicative of IVC obstruction.
- Inferior cavography revealed hepatic IVC stenosis with collateral circulation.
- Ascites were later diagnosed as pancreatic ascites with markedly elevated amylase levels.
Findings:
- Computerized axial tomography and endoscopic retrograde pancreatography confirmed chronic calcific pancreatitis and a pseudocyst.
- Surgical dilatation of the IVC was performed, followed by medical treatment.
- Resolution of IVC stenosis and pancreatic ascites was confirmed by serial imaging (vena cavography, CT, MRI).
Implications:
- This case highlights a novel association between chronic calcific pancreatitis and IVC stenosis, likely due to pancreatitis-induced phlebitis.
- The etiology of chronic calcific pancreatitis may involve alcohol abuse and/or tropical nutritional factors.
- This presentation is the first reported instance of IVC stenosis with pancreatic ascites complicating chronic calcific pancreatitis in Thailand, underscoring the need for comprehensive diagnostic approaches.
Abstract:
A 19-year-old Thai male, who was a regular drinker, presented with massive ascites, back pain and leg edema for four months. On examination there was obvious clinical evidence of an inferior vena cava obstruction. Inferior vena cavography showed narrowing of the hepatic portion of IVC with collateral circulation. Surgical dilatation of the inferior vena cava was performed. The ascites were diagnosed four months later as pancreatic ascites with a very high ascitic amylase level. Computerised axial tomography and endoscopic retrograde pancreatography showed evidence of chronic calcific pancreatitis and pseudocyst. After further medical treatment, ascites and inferior vena cava stenosis subsided which was confirmed by repeated vena cavography, computerised axial tomography and magnetic resonance imaging. The cause of inferior vena cava stenosis and clinical obstruction in this case most likely resulted from phlebitis secondary to pancreatitis. The etiology of chronic calcific pancreatitis in this case might be alcoholic abuse and/or nutritional tropical pancreatitis. Inferior vena cava stenosis and associated pancreatic ascites complicating chronic calcific pancreatitis has not been previously reported in Thailand.