Acute pancreatitis complicated by portal vein thrombus

Case contributed by Dr Henry Knipe

Presentation

Severe abdominal pain for three days. Persistent vomiting, tachycardia, hypotensive.

Patient Data

Age: 60 years
Gender: Male

Peripancreatic fluid and fat stranding tracking inferiorly to the pelvis. Pancreas is swollen. Filling defect in the distal superior mesenteric vein extending into the main and left portal veins. Splenic vein is completely thrombosed. 

Hepatic steatosis. Bilateral simple appearing renal cysts.

Case Discussion

Initial lipase was 1493 IU/L (upper limit of normal 59 IU/L). Subsequent ultrasound did not demonstrate gallstones, and the presumed cause is alcohol.

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