CASE REPORT

JOP. J Pancreas (Online) 2008; 9(4):512-514.

Pancreatic Pseudocyst Causing Celiac Artery Trunk Thrombosis

Christopher Challand1, Daniel Titcomb2, Christopher P Armstrong3

1Gastroenterology Directorate, Derriford Hospital, Plymouth Hospitals NHS Trust. Plymouth, United Kingdom. 2Department of Surgery, Frenchay Hospital, North Bristol NHS Trust. Bristol, United Kingdom

ABSTRACT

Context Vascular complications of pancreatitis are more common in alcohol- rather than gallstone-induced pancreatitis. Such complications are an important cause of mortality and morbidity, although peripancreatic vessel obstruction is a rare consequence. Patients with peripancreatic arterial obstruction can present with sudden and unexplained clinical deterioration requiring prompt diagnosis and intervention.

Case report A 42-year-old woman with a proven pancreatic pseudocyst presented with acute abdominal pain. Initial investigations were non-diagnostic. A gastroscopy revealed patchy necrosis of the proximal stomach. Following sudden clinical deterioration, a contrast-enhanced CT scan was performed. The CT scan demonstrated a thickened gastric wall with intramural gas. The decision was taken to proceed to laparotomy, which revealed both gastric and splenic infarction. A total gastrectomy with Roux-en-Y reconstruction and splenectomy was performed. She made a successful recovery.

Conclusion Arterial thrombosis should be considered in any patient with chronic pancreatitis who presents with an acute clinical deterioration. Successful outcomes can be achieved with prompt diagnosis using contrast-enhanced CT scanning and early surgical intervention.

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Keywords Celiac Artery; Pancreatic Pseudocyst; Thrombosis

Correspondence Christopher Challand: chrischalland@hotmail.com

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