Concurrent acute pancreatitis and splanchnic vein thrombosis in a heavy smoker: a dynamic D-dimer-based diagnostic algorithm and mechanistic insights—a case report
5 affiliations
- 1Department of General Surgery, The First People’s Hospital of Lanzhou City, Lanzhou, Gansu China
- 2The Second Clinical College of Gansu, University of Chinese Medicine, Lanzhou, Gansu China
- 3Department of Interventional Radiology, Lanzhou University First Hospital, Lanzhou, Gansu China
- 4Department of Imaging, The First People’s Hospital of Lanzhou City, Lanzhou, Gansu China
- 5Department of Surgery, Chengguan District Hospital of Lanzhou City, Lanzhou, Gansu China
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.
Case 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.
Conclusions: 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.
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BibTeX
@article{liu2026concurrent,
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}},
author = {Ligang Liu and Fenqiang Li and Tingting Liu and Zhengtao Hu and Jing Zhang},
journal = {Journal of Medical Case Reports},
year = {2026},
month = jul,
doi = {10.1186/s13256-026-06414-z},
url = {https://doi.org/10.1186/s13256-026-06414-z},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Concurrent acute pancreatitis and splanchnic vein thrombosis in a heavy smoker: a dynamic D-dimer-based diagnostic algorithm and mechanistic insights—a case report
AU - Ligang Liu
AU - Fenqiang Li
AU - Tingting Liu
AU - Zhengtao Hu
AU - Jing Zhang
PY - 2026
DA - 2026/07/01
JO - Journal of Medical Case Reports
DO - 10.1186/s13256-026-06414-z
UR - https://doi.org/10.1186/s13256-026-06414-z
AB - 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. Case 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. Conclusions: 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.
SN - 1752-1947
ER -