• Humans
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/mortality
• Male
• Female
• Middle Aged
• Venous Thromboembolism/etiology
• Venous Thromboembolism/epidemiology
• Venous Thromboembolism/mortality
• Adult
• Anticoagulants/therapeutic use
• Anticoagulants/adverse effects
• Retrospective Studies
• Incidence
• Risk Factors
• Aged
• Patient Readmission/statistics & numerical data

• Acute necrotizing pancreatitis
• Case report
• Emphysematous pancreatitis
• Pulmonary embolism

• acute necrotizing pancreatitis
• false aneurysms
• hemorrhagic shock
• pancreatectomy
• venous thrombosis

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas characterized by self-digestion of pancreatic tissue, which can trigger a systemic inflammatory response. Venous thrombosis, resulting from a hypercoagulable state, is a vascular complication of AP. AP complicated by pulmonary embolism (PE) is very rare, and the combined use of extracorporeal membrane oxygenation (ECMO) with a vascular interventional procedure for AP complicated by PE is even rarer.

A 32-year-old man with a history of obesity developed rapidly worsening AP secondary to hypertriglyceridemia. During treatment, the patient developed chest tightness, shortness of breath, and cardiac arrest. Computed tomography (CT) scans of his upper abdomen were consistent with pancreatitis. PE was identified by chest CT angiography involving the right main pulmonary artery and multiple lobar pulmonary arteries. The patient’s D-dimer level was significantly elevated (> 20 mg/L). The patient received high-frequency oxygen inhalation, continuous renal replacement therapies, anti-infective therapy, inhibition of pancreatic secretion, emergent endotracheal intubation, and advanced cardiac life support with cardiopulmonary resuscitation. Following both ECMO and a vascular interventional procedure, the patient recovered and was discharged.

PE is a rare but potentially lethal complication of AP. The early diagnosis of PE is important because an accurate diagnosis and timely interventional procedures can reduce mortality. The combined use of ECMO with a vascular interventional procedure for AP complicated by PE can be considered a feasible treatment method. A collaborative effort between multiple teams is also vital.

• Acute pancreatitis
• Pulmonary embolism
• Extracorporeal membrane oxygenation
• Respiratory distress syndrome
• Case report

• Inferior vena cava
• Post-thrombotic syndrome
• Pulmonary embolism
• Taiwan
• Vena cava filters
• Venous thromboembolism

Acute pancreatitis (AP) is a common critical disease of the digestive system that is often associated with multiple complications. Vascular complications are relatively rare and are one of the causes of death. AP complicated with pulmonary embolism (PE) is even rarer, and there are no reports of AP complicated with PE in elderly patients.

We describe a rare case of AP complicated with PE and review the literature. A 68-year-old woman was diagnosed with AP due to widespread abdominal pain. During the course of treatment, the patient had shortness of breath and progressively worsening dyspnea without chest pain or hemoptysis with a progressive increase in D-dimer and fibrin degradation product. Respiratory failure and right heart failure occurred, and refractory hypoxemia remained after mechanical ventilation. Plain chest computed tomography revealed a small amount of left pleural effusion and external pressure atelectasis in the lower lobe of the left lung but no findings that could lead to refractory hypoxemia. Color Doppler ultrasound indicated pulmonary hypertension and extensive venous thrombosis in the lower extremities. Chest computed tomography angiography finally suggested pulmonary thromboembolism. The patient’s dyspnea symptoms disappeared after anticoagulation treatment.

During the diagnosis and treatment of AP, it is necessary to dynamically monitor D-dimer and consider PE.

• Acute pancreatitis
• Pulmonary embolism
• Vein thrombosis
• D-dimer
• Diagnosis
• Case report

• Pulmonary embolism
• deep vein thrombosis
• hyperlipidaemic acute pancreatitis
• interventional thrombolytic
• plasmapheresis

• Computed Tomography Angiography
• Humans
• Hyperlipidemias
• Male
• Middle Aged
• Pancreatitis
• Pulmonary Embolism
• Radiography, Interventional
• Venous Thrombosis

• pancreatitis
• thromboembolic events
• mortality

Acute pancreatitis in its severe form may lead to systemic inflammatory response syndrome and multisystem organ dysfunction. Acute lung injury is an important cause of mortality in the setting of severe acute pancreatitis. Besides lung involvement, acute and chronic pancreatitis may also lead to the involvement of other thoracic compartments, including mediastinum, pleura, and vascular structures. These manifestations are an important cause of morbidity and may pose diagnostic and therapeutic challenges. These manifestations have not been discussed in detail in the available literature. In this review, we discuss the thoracic complications of pancreatitis, including lung, pleural, mediastinal, and vascular manifestations.

• ALI
• ARDS
• fistula
• pancreatitis
• pleural effusion
• pseudocyst

The study aimed to investigate whether S100A9 gene silencing mediating the IL‐17 pathway affected the release of pro‐inflammatory cytokines in acute pancreatitis (AP). Kunming mice were assigned to the normal, AP, AP + negative control (NC), AP + shRNA, AP + IgG and AP + anti IL‐17 groups. ELISA was applied to measure expressions of AMY, LDH, CRP, TNF‐α, IL‐6 and IL‐8. The cells were distributed into the control, blank, NC, shRNA1 and shRNA2 groups. MTT assay, flow cytometry, RT‐qPCR and Western blotting were used to evaluate cell proliferation, cell cycle and apoptosis, and expressions of S100A9, TLR4, RAGE, IL‐17, HMGB1 and S100A12 in tissues and cells. Compared with the normal group, the AP group displayed increased expressions of AMY, LDH, CRP, TNFα, IL‐6, IL‐8, S100A9, TLR4, RAGE, IL‐17, HMGB1 and S100A12. The AP + shRNA and AP + anti IL‐17 groups exhibited an opposite trend. The in vivo results: Compare with the control group, the blank, NC, shRNA1 and shRNA2 groups demonstrated increased expressions of S100A9, TLR4, RAGE, IL‐17, HMGB1 and S100A12, as well as cell apoptosis and cells at the G1 phase, with reduced proliferation. Compared with the blank and NC groups, the shRNA1 and shRNA2 groups had declined expressions of S100A9, TLR4, RAGE, IL‐17, HMGB1 and S100A12, as well as cell apoptosis and cells at the G1 phase, with elevated proliferation. The results indicated that S100A9 gene silencing suppressed the release of pro‐inflammatory cytokines through blocking of the IL‐17 pathway in AP.

• S100A9
• acute pancreatitis
• interleukin-17 signalling pathway
• pro-inflammatory cytokine

In severe acute pancreatitis (SAP), systemic inflammation leads to endothelial dysfunction and activation of coagulation. Thrombotic disorders in acute pancreatitis (AP) include disseminated intravascular coagulation (DIC). Recently, angiopoietin-2 and soluble fms-like tyrosine kinase 1 (sFlt-1) were proposed as markers of endothelial dysfunction in acute states. Our aim was to assess the frequency of coagulation abnormalities in the early phase of AP and evaluate the relationships between serum angiopoietin-2 and sFlt-1 and severity of coagulopathy. Sixty-nine adult patients with AP were recruited: five with SAP, 15 with moderately severe AP (MSAP) and 49 with mild AP. Six patients were diagnosed with DIC according to International Society on Thrombosis and Haemostasis (ISTH) score. All patients had at least one abnormal result of routine tests of hemostasis (low platelet count, prolonged clotting times, decreased fibrinogen, and increased D-dimer). The severity of coagulopathy correlated with AP severity according to 2012 Atlanta criteria, bedside index of severity in AP and duration of hospital stay. D-dimers correlated independently with C-reactive protein and studied markers of endothelial dysfunction. Angiopoietin-2, D-dimer, and ISTH score were best predictors of SAP, while sFlt-1 was good predictor of MSAP plus SAP. In clinical practice, routine tests of hemostasis may assist prognosis of AP.

• D-dimer
• acute pancreatitis
• angiopoietin-2
• disseminated intravascular coagulation
• soluble fms-like tyrosine kinase 1

• acute pancreatitis
• coagulation
• endothelial injury
• inflammation
• laboratory markers

• Acute Disease
• Animals
• Anticoagulants/therapeutic use
• Biomarkers
• Blood Coagulation
• Cell Communication
• Cytokines/metabolism
• Endothelium/metabolism
• Endothelium/pathology
• Hemostasis
• Humans
• Inflammation/metabolism
• Inflammation/pathology
• Inflammation Mediators/metabolism
• Microcirculation
• Pancreatitis/blood
• Pancreatitis/diagnosis
• Pancreatitis/drug therapy
• Pancreatitis/etiology
• Prognosis
• Severity of Illness Index
• Treatment Outcome