Title:A Good Prognosis of Patients with Acute Pancreatitis Combined with
Pulmonary Embolism: Early Identification and Intervention
Volume: 20
Author(s): Ling-ling Yan, Shao-wei Li, Yu-xin Fang, Xiao-dan Yan and Bi-li He*
Affiliation:
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical University, Linhai, Zhejiang, China
Keywords:
Acute pancreatitis, Pulmonary embolism, Good prognosis, D-dimer, Patients, Diagnosis.
Abstract:
Background:
Pulmonary embolism (PE) is a relatively rare vascular complication of acute pancreatitis (AP), and its mortality rate is high. To our knowledge,
relevant literature reports still need to be summarized. In this study, we analyzed the clinical characteristics, treatment, and prognosis of five
patients with AP complicated by PE and summarized and reviewed the relevant literature.
Methods:
Clinical data of patients with AP complicated by PE treated in Taizhou Hospital of Zhejiang Province between January 2017 and September 2022
were retrospectively collected. Combined with the relevant literature, the clinical characteristics, treatment, and prognoses of patients with AP
combined with PE were analyzed and summarized.
Results:
Five patients were eventually enrolled in this study. Among the five patients with AP complicated by PE, all (100%) had symptoms of malaise,
primarily chest tightness, shortness of breath, and dyspnea. All patients (100%) had varied degrees of elevated D-dimer levels and a significant
decrease in the pressure of partial oxygen (PO2) and pressure of arterial oxygen to fractional inspired oxygen concentration ratio (PaO2/FiO2).
Computed tomographic angiography (CTA) or pulmonary ventilation/perfusion imaging revealed a pulmonary artery filling defect in these
patients. One patient (20%) had left calf muscular venous thrombosis before the occurrence of PE. Four patients (80%) were treated with lowmolecular-
weight heparin (LMWH), and one patient (20%) was treated with rivaroxaban during hospitalization; all continued oral anticoagulant
therapy after discharge. All patients (100%) were cured and discharged. No patients showed recurrence of AP or PE.
Conclusion:
PE is a rare but life-threatening complication of AP. However, once diagnosed, early treatment with anticoagulation or radiological interventional
procedures is effective, and the prognosis is good.
Core Tips:
Pulmonary embolism (PE) is a rare but life-threatening complication of acute pancreatitis (AP). Its early diagnosis and timely anticoagulation or
radiological intervention can reduce mortality. However, only nine cases have been reported in the English literature thus far, and they are all case
reports. Our study is the first systematic analysis of patients with AP combined with PE with a review of the relevant literature. Our patients and
those reported in the literature were discharged with good prognoses under treatment such as anticoagulation and vascular intervention. These
cases remind clinicians that, in patients with AP, especially those with risk factors for venous thrombosis, it is necessary to monitor the D-dimer
level dynamically. Clinicians should pay attention to AP patients' symptoms and related examinations to reduce the chance of a missed diagnosis
or misdiagnosis of PE.
