Coeliac Artery Trunk Thrombosis in Acute Pancreatitis Causing Total Gastric Necrosis

Chinnappan, Kumaran; Chung, Alexander Y. F.; Ooi, London Lucien Peng Jin; Chow, Pierce K. H.; Wong, Wai‐Keong

doi:10.1111/j.1445-2197.2006.03701.x

Cited by 20 publications

(17 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…18 The features of disseminated intravascular coagulation may be evident in some patients. Thrombotic occlusion of the celiac trunk may be a possible mechanism of total gastric necrosis, and has been reported as a rare complication following acute pancreatitis 9 though not in association with APS. It is likely that in the present cases the pathogenesis was probably either a similar occlusion or a more deadly variety, the "catastrophic APS," with small vessel occlusion being the cause of gangrene.…”

Section: Discussionmentioning

confidence: 97%

“…3,4 Visceral involvement is rare, more so for the stomach, since the organ has a robust blood supply. Although other causes of gastric necrosis/ gangrene including volvulus, 5 diaphragmatic hernia, 6 acute necrotizing gastritis, 7 caustic ingestion, 8 and acute pancreatitis 9 have been infrequently reported, gangrene of stomach due to APS is not known. This report describes two cases of gastric gangrene with primary APS of which one patient could be salvaged while the other succumbed to respiratory distress syndrome in the postoperative period.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Massive gangrene of the stomach due to primary antiphospholipid syndrome: Report of two cases

et al. 2010

View full text Add to dashboard Cite

Antiphospholipid syndrome (APS) is a systemic autoimmune disease, which may be primary or secondary to other autoimmune diseases. It produces thrombosis of arteries and veins of any caliber, and no organ is immune to its insult. This report describes two cases of massive gastric gangrene due to primary APS, which presented in a span of 2 years. In the first case a multiparous, 40-year-old woman presented with acute abdominal pain, hematemesis, and progressive abdominal distension, and was in azotemia and shock. A laparotomy revealed gangrene of the stomach without any other organ involvement. She was managed with a total gastrectomy and esophagojejunal anastomosis. Postoperative serology revealed a persistent elevation of anticardiolipin antibody with no other apparent predisposing cause. The histopathological examination of the specimen revealed characteristic extensive intramural vascular thrombosis without inflammatory changes in the vessel wall, confirming antiphospholipid syndrome. The second patient was a primiparous, 26-year-old woman who had severe abdominal pain in the first trimester followed by shock. An exploratory laparotomy revealed massive gangrene of the stomach with complete loss of the posterior wall and hemoperitoneum. She also underwent a total gastrectomy with esophagogastric anastomosis and was later managed in the intensive care unit, where she succumbed within 8 days. Her serology showed a highly elevated anticardiolipin antibody titer, and histopathological examination of the stomach revealed characteristic intramural vascular thrombosis without inflammatory cellular infiltrate in the vessel wall. Patients undergoing a total gastrectomy following acute gastric necrosis have very high mortality (50%-80%). Its association with APS is rare and it has not been previously reported. The combination is a formidable challenge to the physician and a dangerous disease for the patient. The rarity of the condition and its grave prognosis is highlighted.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Massive gangrene of the stomach due to primary antiphospholipid syndrome: Report of two cases

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Pancreatitis is a common etiologic factor in patients with celiac artery thrombosis. Kumaran et al [6] reported a case with isolated celiac trunk thrombosis caused by local complication of acute pancreatitis. They performed laparotomy due to clinical deterioration.…”

Section: Discussionmentioning

confidence: 99%

Splenic infarction as a complication of celiac artery thromboembolism: an unusual cause of abdominal pain

et al. 2011

View full text Add to dashboard Cite

Splenic infarction is a relatively uncommon diagnosis and this clinical presentation can mimic other causes of acute abdominal pain. Cardiologic and hematologic disorders are common reasons for this entity. There have been a few series and single case reports of splenic infarction published in peer-reviewed medical journals. We report a 53-year-old patient who had splenic infarction caused by celiac artery thromboembolism. The importance of this case, without any etiological predisposing factors, is that this kind of clinical situation should be considered in the differential diagnosis of abdominal pain.

show abstract

“…1 In addition, there have been reports of two cases of a retropancreatic intra-aortic mural thrombus linked to severe pancreatitis. 2 In these three cases, the arterial thrombosis was localised to vessels adjacent to the pancreas.…”

Section: Figure 1 Ct Scan Two Days After Admissionmentioning

confidence: 99%

A case of widespread aortic thrombosis secondary to acute severe pancreatitis

Mishreki

Bowles

2011

annals

View full text Add to dashboard Cite

A 29-year-old male was admitted with a 3-day history of increasing epigastric and back pain. With a raised serum amylase within the diagnostic limits for acute pancreatitis and with deranged liver function tests, the patient was started on the standard treatment for acute pancreatitis. This included intravenous fluids, oxygen, urine output monitoring with strict fluid balance charting, a proton-pump inhibitor, venous thromboembolism prophylaxis and antibiotics (in accordance with our local policy).An abdominal computer tomography (CT) scan performed two days after admission showed widespread necrotising pancreatitis. The patient deteriorated subsequently, becoming increasingly hypoxic and requiring intubation and ventilation. He was transferred to our unit for further care.The CT scan also revealed the presence of multiple thrombi throughout the length of the aorta. A CT aortogram was therefore performed after the patient was stabilised. This showed extensive arterial thrombus throughout the arch vessels and thoracic and abdominal aorta (Fig 1). The CT demonstrated thrombus present at the origin of the right innominate and left common carotid artery, and two separate large areas of thrombus present in the proximal and mid descending thoracic aorta. Further thrombus was present at the diaphragmatic hiatus, with yet more thrombus in the juxtarenal abdominal aorta, extending into the origin of the left renal artery. The coeliac trunk, splenic artery, common hepatic artery and superior mesenteric artery were unaffected. A thrombophilia screen was performed and was normal.The patient had a complicated past medical history, suffering from chronic pain syndrome since his early childhood, with widespread joint and muscle involvement. As such, he had been extensively investigated by rheumatologists, orthopaedic surgeons and psychiatrists. He was a heavy smoker and had been housebound for the previous two years.A CT scan had been performed one year prior to this episode as part of haematological investigations into the cause of a lymphocytosis. This did not show any evidence of aortic thrombus at that time (Fig 2). It would therefore seem likely that the cause of the widespread aortic thrombus formation was acute severe pancreatitis. The alternative is that the acute pancreatitis was secondary to the aortic thrombosis and visceral ischaemia. However, this is improbable as the coeliac trunk, superior mesenteric artery and their main branches were patent on the CT scan.The patient was anticoagulated with an intravenous heparin infusion on the basis that the risk from propagation of the aortic thrombus was greater than that of bleeding from his necrotic pancreas. The patient was successfully managed non-operatively on the intensive care unit for a total of eight days before being moved to the ward. Intravenous heparin infusion was then converted to subcutaneous low-molecular weight heparin at treatment dose. He continued to improve and was transferred back to the referring hospital for further management, including a cholecy...

show abstract

Coeliac Artery Trunk Thrombosis in Acute Pancreatitis Causing Total Gastric Necrosis

Cited by 20 publications

References 12 publications

Massive gangrene of the stomach due to primary antiphospholipid syndrome: Report of two cases

Massive gangrene of the stomach due to primary antiphospholipid syndrome: Report of two cases

Splenic infarction as a complication of celiac artery thromboembolism: an unusual cause of abdominal pain

A case of widespread aortic thrombosis secondary to acute severe pancreatitis

Contact Info

Product

Resources

About