J Med Cases

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

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

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

Chronic Pancreatitis-Induced Thrombosis of Celiac and Superior Mesenteric Artery

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. 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. 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
Study	Age	Gender	History of thrombosis	Other relevant history	Etiology of pancreatitis	Severity	Location of arterial thrombus	Management of thrombus
HTN: hypertension; HLD: hyperlipidemia; CKD: chronic kidney disease; DM: diabetes mellitus; SMA: superior mesenteric artery.
Vogel et al (1967) [6]	40	Male	No	Alcoholic cirrhosis	Not mentioned	Severe (necrotizing)	Bilateral renal arteries	Thrombus found post-mortem
Hahn et al (1999) [9]	41	Male	No	Rheumatoid arthritis, Rous-en-Y duodenojejunostomy due to pancreaticoduodenal trauma	Not mentioned	Unclear - but no necrotic pancreas	Aortic thrombus - no further specification	IV heparin drip with transition to warfarin
	74	Male	No	Crohn’s disease, DM, HTN, total colectomy for complications from Crohn’s disease	Not mentioned	Unclear - but no necrotic pancreas	Peripancreatic aorta with distal emboli to the toes
Challand et al (2008) [3]	43	Female	No	Alcoholic abuse	Alcohol-induced	Chronic pancreatitis complicated by pseudocyst formation	Celiac trunk	Total gastrectomy with Roux-en-Y reconstruction and splenectomy
Mishreki et al (2011) [5]	29	Male	No	Chronic pain syndrome, immobile	Not mentioned	Severe (necrotizing)	Left renal artery, aortic arch, right innominate and left common carotid artery, juxtarenal abdominal aorta	IV heparin infusion drip with transition to therapeutic dose of subcutaneous low-molecular weight heparin
Thajudeen et al (2013) [10]	66	Female	No	HTN, low-back pain	Not mentioned	Severe (necrotizing)	Bilateral renal arteries	IV heparin drip and transition to oral anticoagulation
Verbeeck et al (2014) [12]	50	Female	Not mentioned	Not mentioned	Not mentioned	Severe (necrotizing)	Infrarenal abdominal aorta	IV heparin drip followed by subcutaneous heparin
Chong et al (2016) [7]	66	Male	No	HTN, alcohol abuse	Gallstones	Severe (necrotizing)	Ascending aorta with left kidney emboli	Surgery (cardiopulmonary bypass and mediastinal debridement) IV heparin transitioned to oral warfarin
Garcia-Rodriquez et al (2019) [11]	60	Female	No	HTN, T2DM, spinal stenosis	Not mentioned	Unclear - but no necrotic pancreas	Abdominal aorta (from renal artery level to aortic bifurcation) and SMA	IV heparin drip and transition to warfarin
Chait et al (2019) [8]	45	Female	No	Obesity, HTN, HLD, CKD, fibromyalgia, Graves’ disease with total thyroidectomy, breast cancer with lumpectomy and radiation	Acute postoperative pancreatitis (from laparoscopic cholecystectomy)	Severe (necrotizing)	SMA	Tissue plasminogen activator, mechanical thrombectomy, IV heparin drip

Table 1. A Summarization of All the Cases of Arterial Thrombosis in the Setting of Pancreatitis

Study

Age

Gender

History of thrombosis

Other relevant history

Etiology of pancreatitis

Severity

Location of arterial thrombus

Management of thrombus

HTN: hypertension; HLD: hyperlipidemia; CKD: chronic kidney disease; DM: diabetes mellitus; SMA: superior mesenteric artery.

Vogel et al (1967) [6]

Male

Alcoholic cirrhosis

Not mentioned

Severe (necrotizing)

Bilateral renal arteries

Thrombus found post-mortem

Hahn et al (1999) [9]

Male

Rheumatoid arthritis, Rous-en-Y duodenojejunostomy due to pancreaticoduodenal trauma

Not mentioned

Unclear - but no necrotic pancreas

Aortic thrombus - no further specification

IV heparin drip with transition to warfarin

Male

Crohn’s disease, DM, HTN, total colectomy for complications from Crohn’s disease

Not mentioned

Unclear - but no necrotic pancreas

Peripancreatic aorta with distal emboli to the toes

Challand et al (2008) [3]

Female

Alcoholic abuse

Alcohol-induced

Chronic pancreatitis complicated by pseudocyst formation

Celiac trunk

Total gastrectomy with Roux-en-Y reconstruction and splenectomy

Mishreki et al (2011) [5]

Male

Chronic pain syndrome, immobile

Not mentioned

Severe (necrotizing)

Left renal artery, aortic arch, right innominate and left common carotid artery, juxtarenal abdominal aorta

IV heparin infusion drip with transition to therapeutic dose of subcutaneous low-molecular weight heparin

Thajudeen et al (2013) [10]

Female

HTN, low-back pain

Not mentioned

Severe (necrotizing)

Bilateral renal arteries

IV heparin drip and transition to oral anticoagulation

Verbeeck et al (2014) [12]

Female

Not mentioned

Severe (necrotizing)

Infrarenal abdominal aorta

IV heparin drip followed by subcutaneous heparin

Chong et al (2016) [7]

Male

HTN, alcohol abuse

Gallstones

Severe (necrotizing)

Ascending aorta with left kidney emboli

Surgery (cardiopulmonary bypass and mediastinal debridement) IV heparin transitioned to oral warfarin

Garcia-Rodriquez et al (2019) [11]

Female

HTN, T2DM, spinal stenosis

Not mentioned

Unclear - but no necrotic pancreas

Abdominal aorta (from renal artery level to aortic bifurcation) and SMA

IV heparin drip and transition to warfarin

Chait et al (2019) [8]

Female

Obesity, HTN, HLD, CKD, fibromyalgia, Graves’ disease with total thyroidectomy, breast cancer with lumpectomy and radiation

Acute postoperative pancreatitis (from laparoscopic cholecystectomy)

Severe (necrotizing)

SMA

Tissue plasminogen activator, mechanical thrombectomy, IV heparin drip