Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 904-911
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.904
Acute pancreatitis with pulmonary embolism: A case report
Xue-Ling Fu, Fa-Ke Liu, Ming-Dong Li, Chang-Xue Wu
Xue-Ling Fu, Emergency Intensive Care Unit, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Fa-Ke Liu, Chang-Xue Wu, Department of Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Ming-Dong Li, Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Author contributions: Fu XL designed this report and drafted the manuscript; Li MD acquired data and analyzed data; Liu FK collected the clinical information; Wu CX edited and revised the manuscript; All authors issued final approval for the version to be submitted.
Supported by Sichuan Provincial Health Department Fund, No. 17PJ396.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Xue Wu, PhD, Doctor, Department of Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou 646000, Sichuan Province, China. wuchangxue12@163.com
Received: September 16, 2020
Peer-review started: September 16, 2020
First decision: November 13, 2020
Revised: December 1, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: February 6, 2021
Processing time: 131 Days and 1.4 Hours
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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

Keywords: Acute pancreatitis; Pulmonary embolism; Vein thrombosis; D-dimer; Diagnosis; Case report

Core Tip: Acute pancreatitis complicated with pulmonary embolism (PE) is very rare, and the mortality rate is extremely high if not detected in time. PE often coexists with other complications that can affect respiratory function and is easily missed and misdiagnosed. This report describes the first case of acute pancreatitis complicated by PE in an elderly patient. Clinicians should be reminded that it is important to dynamically monitor blood coagulation indicators such as D-dimer during the diagnosis and treatment of acute pancreatitis and to be alert to the occurrence of deep vein thrombosis and PE to reduce missed diagnosis and misdiagnosis.