Necrotizing pancreatitis complicated by portal and splenic vein thrombosis

Case contributed by Henry Knipe


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

Patient Data

Age: 60 years
Gender: Male

Peripancreatic free fluid and fat stranding particularly around the pancreatic tail, tracking inferiorly to the pelvis and superiorly into the left subphrenic space. Pancreas is swollen with regions of hypoattenuation in the tail and uncinate process consistent with necrosis. Distal superior mesenteric vein thrombosis with thrombosis also of the main portal and left portal veins.

Splenic vein is wholly thrombosed. Mild splenic heterogeneity may be related to this thrombosis.

Hepatic steatosis. Bilateral simple-appearing renal cysts.

Case Discussion

This is a case of complicated necrotizing pancreatitis. 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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