Pancreatic pseudocyst causing celiac artery trunk thrombosis.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Challand
Christopher
C
Gastroenterology Directorate, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom. chrischalland@hotmail.com
Titcomb
Daniel
D
Armstrong
Christopher P
CP
D000328:Adult; D000437:Alcoholism / Q000150:complications; D000713:Anastomosis, Roux-en-Y; D002445:Celiac Artery / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007813:Laparotomy; D009336:Necrosis; D010192:Pancreatic Pseudocyst / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D050500:Pancreatitis, Chronic / Q000150:complications; D013154:Spleen / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D013156:Splenectomy; D013159:Splenic Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013270:Stomach / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome