Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 14, Number 9-10, October 2023, pages 322-326

Chronic Pancreatitis-Induced Thrombosis of Celiac and Superior Mesenteric Artery


Figure 1.
Figure 1. (a) Complete superior mesenteric artery thrombosis (red arrow), indicated by the filling defect. (b) Celiac artery narrowing/stenosis indicating chronic thrombosis (orange arrow).
Figure 2.
Figure 2. Coronal view of CT of abdomen/pelvis. There is prominent jejunal wall thickening with layers of high and low attenuation indicating submucosal edema from likely from acute ischemia (yellow arrow). CT: computed tomography.
Figure 3.
Figure 3. CT of abdomen/pelvis 6 months prior showing patent CA and SMA as they branch from the abdominal aorta (yellow circle). CT: computed tomography; CA: celiac artery; SMA: superior mesenteric artery.


Table 1. A Summarization of All the Cases of Arterial Thrombosis in the Setting of Pancreatitis
StudyAgeGenderHistory of thrombosisOther relevant historyEtiology of pancreatitisSeverityLocation of arterial thrombusManagement of thrombus
HTN: hypertension; HLD: hyperlipidemia; CKD: chronic kidney disease; DM: diabetes mellitus; SMA: superior mesenteric artery.
Vogel et al (1967) [6]40MaleNoAlcoholic cirrhosisNot mentionedSevere (necrotizing)Bilateral renal arteriesThrombus found post-mortem
Hahn et al (1999) [9]41MaleNoRheumatoid arthritis, Rous-en-Y duodenojejunostomy due to pancreaticoduodenal traumaNot mentionedUnclear - but no necrotic pancreasAortic thrombus - no further specificationIV heparin drip with transition to warfarin
74MaleNoCrohn’s disease, DM, HTN, total colectomy for complications from Crohn’s diseaseNot mentionedUnclear - but no necrotic pancreasPeripancreatic aorta with distal emboli to the toes
Challand et al (2008) [3]43FemaleNoAlcoholic abuseAlcohol-inducedChronic pancreatitis complicated by pseudocyst formationCeliac trunkTotal gastrectomy with Roux-en-Y reconstruction and splenectomy
Mishreki et al (2011) [5]29MaleNoChronic pain syndrome, immobileNot mentionedSevere (necrotizing)Left renal artery, aortic arch, right innominate and left common carotid artery, juxtarenal abdominal aortaIV heparin infusion drip with transition to therapeutic dose of subcutaneous low-molecular weight heparin
Thajudeen et al (2013) [10]66FemaleNoHTN, low-back painNot mentionedSevere (necrotizing)Bilateral renal arteriesIV heparin drip and transition to oral anticoagulation
Verbeeck et al (2014) [12]50FemaleNot mentionedNot mentionedNot mentionedSevere (necrotizing)Infrarenal abdominal aortaIV heparin drip followed by subcutaneous heparin
Chong et al (2016) [7]66MaleNoHTN, alcohol abuseGallstonesSevere (necrotizing)Ascending aorta with left kidney emboliSurgery (cardiopulmonary bypass and mediastinal debridement) IV heparin transitioned to oral warfarin
Garcia-Rodriquez et al (2019) [11]60FemaleNoHTN, T2DM, spinal stenosisNot mentionedUnclear - but no necrotic pancreasAbdominal aorta (from renal artery level to aortic bifurcation) and SMAIV heparin drip and transition to warfarin
Chait et al (2019) [8]45FemaleNoObesity, HTN, HLD, CKD, fibromyalgia, Graves’ disease with total thyroidectomy, breast cancer with lumpectomy and radiationAcute postoperative pancreatitis (from laparoscopic cholecystectomy)Severe (necrotizing)SMATissue plasminogen activator, mechanical thrombectomy, IV heparin drip