{
  "abstract": "Background: Splanchnic vein thrombosis (SVT) concurrent with acute pancreatitis (AP) at initial diagnosis is rare and its pathophysiology remains unclear. We describe a heavy smoker who presented with AP with occult non-occlusive SVT, which paradoxically progressed to complete thrombotic occlusion.\n\nCase presentation: A 52-year-old male heavy smoker (40–60 cigarettes/day for 30 years) presented with epigastric pain and was diagnosed with AP after excluding common etiologies. On admission, D-dimer was markedly elevated at 9.15 mg/L (18 times the upper limit of normal). By day 12, despite radiological resolution of pancreatic inflammation and a significant c-reactive protein (CRP) reduction (139.16 to 45.35 mg/L), he developed mesenteric ischemia. Laboratory findings revealed a paradoxical “dynamic decoupling”: D-dimer further escalated to 9.52 mg/L, fibrinogen (FIB) was consumed to 2.72 g/L, and antithrombin III (AT-III) was critically depleted to 45%. Contrast-enhanced CT confirmed complete thrombotic occlusion of the superior mesenteric, splenic, and portal veins; retrospective review verified non-occlusive SVT at onset. Standard systemic anticoagulation failed to halt thrombotic progression, reaching a “pharmacological ceiling” due to profound AT-III depletion. Transjugular endovascular intervention (thrombus aspiration and catheter-directed thrombolysis) successfully reversed the intestinal ischemia.\n\nConclusions: In heavy smokers with AP, an initial D-dimer exceeding 18 times the upper limit of normal should prompt early contrast-enhanced CT to exclude occult SVT. When standard systemic anticoagulation fails due to a “pharmacological ceiling” of depleted antithrombin, timely endovascular escalation is a key salvage strategy.",
  "abstract_shown": true,
  "affiliations": [
    "Department of General Surgery, The First People’s Hospital of Lanzhou City, Lanzhou, Gansu China",
    "The Second Clinical College of Gansu, University of Chinese Medicine, Lanzhou, Gansu China",
    "Department of Interventional Radiology, Lanzhou University First Hospital, Lanzhou, Gansu China",
    "Department of Imaging, The First People’s Hospital of Lanzhou City, Lanzhou, Gansu China",
    "Department of Surgery, Chengguan District Hospital of Lanzhou City, Lanzhou, Gansu China"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Ligang Liu"
    },
    {
      "affs": [
        2
      ],
      "name": "Fenqiang Li"
    },
    {
      "affs": [
        3
      ],
      "name": "Tingting Liu"
    },
    {
      "affs": [
        4
      ],
      "name": "Zhengtao Hu"
    },
    {
      "affs": [
        4
      ],
      "name": "Jing Zhang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5j96xyn9csaya.bib",
  "cited_by": 0,
  "doi": "10.1186/s13256-026-06414-z",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13711886/",
  "id": "5j96xyn9csaya",
  "issns": [
    "1752-1947"
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  "landing_url": "https://doi.org/10.1186/s13256-026-06414-z",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
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      "heading",
      "Case Report"
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      "lcc",
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      "openalex",
      "2746|Abdominal vascular conditions and treatments"
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  "openalex": "W7171859119",
  "pdf_url": null,
  "pmcid": "PMC13711886",
  "pmid": "42934804",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/5j96xyn9csaya.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:22:35Z",
      "native_id": "PMC13711886",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s13256-026-06414-z"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Abdominal vascular conditions and treatments",
      "subfield": "surgery"
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  ],
  "title": "Concurrent acute pancreatitis and splanchnic vein thrombosis in a heavy smoker: a dynamic D-dimer-based diagnostic algorithm and mechanistic insights—a case report",
  "title_text": "Concurrent acute pancreatitis and splanchnic vein thrombosis in a heavy smoker: a dynamic D-dimer-based diagnostic algorithm and mechanistic insights—a case report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T14:20:49Z",
  "url": "https://research.draconitic.com/paper/5j96xyn9csaya",
  "venue": "Journal of Medical Case Reports",
  "versions": []
}