Lifesaving Procedure of Endovascular Stent Grafting for Unusual Superior Mesenteric Vein Erosion in Necrotizing Pancreatitis
In a recent medical case, a 41-year-old male with a history of hypertension and hyperlipidemia developed acute pancreatitis and acute kidney injury. The patient's condition worsened, leading to severe necrotizing pancreatitis complicated by abdominal compartment syndrome.
The patient underwent decompressive laparotomies and necrosectomies due to worsening necrosis, pseudocyst formation, and nontraumatic abdominal compartment syndrome leading to end organ damage. However, the patient developed an acute, life-threatening hemorrhage due to pancreatic enzyme erosion of the superior mesenteric vein (SMV).
Frank bloody output from his Jackson-Pratt (JP) drain prompted an urgent computed tomography angiography (CTA). The CTA revealed an arterial source of bleeding from a branch of the celiac artery. Despite surgical attempts to control the bleeding, they were unsuccessful.
The IR team was consulted, and endovascular interventions, such as venous stent grafting, were deemed necessary. The bleeding was successfully controlled with SMV stenting, with subsequent surgical confirmation of the exposed stent within the disrupted venous wall.
This is the first reported case of SMV erosion treated with endovascular stent grafting in the context of necrotizing pancreatitis. Reported cases of SMV erosion specifically in necrotizing pancreatitis treated with endovascular stent grafting appear to be very rare or not well documented in the current literature.
While mesenteric venous thrombosis and vascular complications such as pseudoaneurysms from pancreatitis are recognized, there is no direct mention of SMV erosion treated by endovascular stent grafting in these references. The patient required mechanical ventilation for hypoxic respiratory failure and was eventually discharged after recovery.
The case underscores the complexity of vascular injuries in pancreatitis. It adds to the limited but growing body of evidence supporting the use of venous stenting for mesenteric venous injuries in necrotizing pancreatitis. If more detailed information or case reports on this precise topic are required, a focused search in specialized vascular surgery or interventional radiology case report journals or databases may be necessary.
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