Disturbances of the microcirculation in acute pancreatitis

Cuthbertson, Christine M.; Christophi, Christopher

doi:10.1002/bjs.5316

Cited by 252 publications

(193 citation statements)

References 138 publications

(237 reference statements)

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“…It it possible for this micro-thrombosis to be the key vascular event in acute necrotic pancreatitis [25][26][27][28][29]. These lesions may be observed in the early stages when stromal edema appears and there is no necrosis as yet.…”

Section: Resultsmentioning

confidence: 99%

Pancreatic Acinar and Island Vascular Apparatus Associated with Acute and Chronic Inflammatory Processes

Mateescu¹,

Oprea²,

Stanca³

et al. 2015

Acute and Chronic Pancreatitis

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Section: Resultsmentioning

confidence: 99%

Pancreatic Acinar and Island Vascular Apparatus Associated with Acute and Chronic Inflammatory Processes

Mateescu¹,

Oprea²,

Stanca³

et al. 2015

Acute and Chronic Pancreatitis

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“…In acute pancreatitis, levels of fibrinogen and D-Dimer are raised, and the overall platelet level is increased (11,12). Furthermore, disturbances in the coagulation cascade likely lead to further hypercoagulability and activation of fibrinolysis (13).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism and acute pancreatitis: Case series and review

Deiss

Young²,

Yeh³

et al. 2020

Turk J Gastroenterol

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Reports of pulmonary embolism in the setting of acute pancreatitis are rare. We present three cases of acute pancreatitis associated with pulmonary embolism and review the literature. Two of the three patients had severe acute pancreatitis with bilateral pulmonary emboli, and to our knowledge, these cases represent the first report of pulmonary embolism occurring in the setting of pancreatic ascites and pleural effusion. All patients experienced abdominal pain, though in one patient, symptoms suggestive of a pulmonary embolism were lacking. All three patients were successfully treated with unfractionated heparin and conservative management. Pulmonary thrombosis may occur in the setting of severe acute pancreatitis as the result of systemic inflammatory response. We review the literature and provide microvascular explanations for the occurrence of pulmonary complications and thrombosis in the setting of acute pancreatitis. We also review prior cases of pulmonary embolism in acute pancreatitis. Our experience suggests that pulmonary embolism may be an under-recognized complication of severe acute pancreatitis. Keywords: Pulmonary embolism, pancreatitis, ascites, pleural effusion, thrombosis INTRODUCTIONSevere acute pancreatitis can provoke a systemic inflammatory response which may lead to a number of vascular and pulmonary complications. Pulmonary embolism is a rarely reported complication of acute pancreatitis (1-3). Here we present three cases of acute pancreatitis associated with pulmonary embolism, and propose that pulmonary vascular thrombosis may be an underrecognized complication of severe acute pancreatitis. To our knowledge, two of the three cases represent the first reports of pulmonary embolism occurring in the setting of pancreatic ascites and pleural effusion. CASE PRESENTATIONSCase 1 A 28 year old woman presented with six weeks of abdominal pain along with nausea and vomiting. The patient had a history of alcoholic pancreatitis but denied recent alcohol consumption. She reported no chest pain or shortness of breath. Initial vital signs included a temperature of 98.7 F, blood pressure of 122/87 mmHg, and she was tachycardic with a heart rate of 132 beats/ min. Oxygen saturation was 95% on room air. Physical examination was remarkable for epigastric tenderness and abdominal distention consistent with ascites. Lipase was 1,453 IU/L, and liver enzymes were normal. Ascitic fluid analysis showed an amylase of 43,400 IU/L. CT scan of the abdomen and pelvis showed ascites and evidence of prior cholecystectomy. Incidental, multiple pulmonary emboli were seen in bilateral lower lobes, along with a right-sided pleural effusion and lower lobe consolidation with abnormal enhancement, consistent with pulmonary infarct (Figure 1). The pancreas appeared normal.The patient was started on unfractionated heparin along with intravenous hydration and bowel rest. Her abdominal pain and nausea quickly improved, and she tolerated an oral diet within three days. She was discharged with low-molecular weight heparin a...

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“…Although there is no direct evidence for vascular involvement in the pancreas of patients with the A3243G mutation, it is known that this organ is susceptible to ischemic injury, and perturbations of the systemic and pancreatic micro-vascularization play a significant role in the pathogenesis of pancreatitis [6]. In addition, mitochondrial diseases, including MELAS, are associated with an excess production of reactive oxygen species (ROC), which mostly occurs in the mitochondria as byproducts of oxidative phosphorylation, and has been described as an important factor in the pathogenesis and progression of pancreatitis [23].…”

Section: Discussionmentioning

confidence: 99%

Application of molecular imaging combined with genetic screening in diagnosing MELAS, diabetes and recurrent pancreatitis

Wang

Li²,

Zhou³

et al. 2016

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Disturbances of the microcirculation in acute pancreatitis

Abstract: Acute pancreatitis impairs the pancreatic and systemic microcirculation, which is a key pathological process in the development of severe necrotizing disease.

Cited by 252 publications

References 138 publications

Pancreatic Acinar and Island Vascular Apparatus Associated with Acute and Chronic Inflammatory Processes

Pancreatic Acinar and Island Vascular Apparatus Associated with Acute and Chronic Inflammatory Processes

Pulmonary embolism and acute pancreatitis: Case series and review

Application of molecular imaging combined with genetic screening in diagnosing MELAS, diabetes and recurrent pancreatitis

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