Abstract
The management of pancreatitis can be daunting, especially when associated with other comorbidities. These complexities in management are conflicting in the presence of comorbidities with a similar presentation, such as abdominal pain. Acute pancreatitis (AP) has been associated with mesenteric thrombosis but less commonly with superior mesenteric vein thrombosis (SMVT) as a causal or complicating dilemma. This case report describes the careful intrigues and overlaps in presentation. Furthermore, this paper presents a dilemma in that contrast-enhanced computed tomography (CT) may not be recommended in the early stage of diagnosis of AP according to the 2013 American College of Gastroenterology (ACG) guideline, but SMVT, which can be fatal, sometimes, complicates AP, and contrast-enhanced CT is important in its diagnosis. This paper attempts to address this dilemma. Managing these two potentially fatal pathologies requires promptness and thoughtfulness in averting a deadly outcome. Because SMVT is fatal, in this paper, we reiterate the use of contrast-enhanced CT in the early stages of the management of AP. Fatal complications from AP should not be missed. Although contrast-enhanced CT is not recommended in the early stages of diagnosis of AP in the ACG guideline, fatal complications such as SMVT can be avoided.
Highlights
Pancreatitis is one of the common gastrointestinal diseases characterized by inflammation of the pancreas, leading to a systemic inflammatory response [1]
This paper presents a dilemma in that contrast-enhanced computed tomography (CT) may not be recommended in the early stage of diagnosis of Acute pancreatitis (AP) according to the 2013 American College of Gastroenterology (ACG) guideline, but superior mesenteric vein thrombosis (SMVT), which can be fatal, sometimes, complicates AP, and contrast-enhanced CT is important in its diagnosis
Contrast-enhanced CT is not recommended in the early stages of diagnosis of AP in the ACG guideline, fatal complications such as SMVT can be avoided
Summary
Pancreatitis is one of the common gastrointestinal diseases characterized by inflammation of the pancreas, leading to a systemic inflammatory response [1]. It is known that pancreatitis occurring with isolated superior mesenteric vein thrombosis (SMVT) alone is generally associated with a neoplasm or intra-abdominal sepsis [2] Both entities' diagnostic and treatment guidelines share disparities and similarities that may pose a dilemma during management. The patient is a middle-aged male with a past medical history of pancreatitis and alcohol use disorder who was admitted for epigastric pain, described as a stabbing, non-colicky pain that radiated to the back, relieved by position (knee-to-chest-position) with no aggravating factor. He reported that the pain started gradually about 24 hours before presentation after taking 10 glasses of vodka and gin two days before presentation. After several weeks of follow-up in our outpatient clinic, the patient reports no abdominal pain and is still on a therapeutic anticoagulant (rivaroxaban)
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call