Case Report
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2012; 18(42): 6168-6171
Published online Nov 14, 2012. doi: 10.3748/wjg.v18.i42.6168
Should anticoagulants be administered for portal vein thrombosis associated with acute pancreatitis?
Won-Seok Park, Hyeong-Il Kim, Byung-Jun Jeon, Seong-Hun Kim, Seung-Ok Lee
Won-Seok Park, Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 301-723, South Korea
Hyeong-Il Kim, Byung-Jun Jeon, Seong-Hun Kim, Seung-Ok Lee, Division of Gastroenterology, Department of Internal Medicine, Chonbuk National University College of Medicine, Jeonju 561-712, South Korea
Author contributions: Park WS and Lee SO contributed equally to this work; Park WS, Kim HI, Jeon BJ, Kim SH and Lee SO took part in the design of the study, were involved in patient treatment, and participated in writing the manuscript.
Correspondence to: Seung-Ok Lee, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Chonbuk National University College of Medicine, Geumam 2-dong, Deokjin-gu, Jeonju 561-712, South Korea. solee@jbnu.ac.kr
Telephone: +82-63-2501533 Fax: +82-63-2541609
Received: March 23, 2012
Revised: August 6, 2012
Accepted: August 14, 2012
Published online: November 14, 2012
Abstract

Venous complications in patients with acute pancreatitis typically occur as a form of splenic, portal, or superior mesenteric vein thrombosis and have been detected more frequently in recent reports. Although a well-organized protocol for the treatment of venous thrombosis has not been established, anticoagulation therapy is commonly recommended. A 73-year-old man was diagnosed with acute progressive portal vein thrombosis associated with acute pancreatitis. After one month of anticoagulation therapy, the patient developed severe hematemesis. With endoscopy and an abdominal computed tomography scan, hemorrhages in the pancreatic pseudocyst, which was ruptured into the duodenal bulb, were confirmed. After conservative treatment, the patient was stabilized. While the rupture of a pseudocyst into the surrounding viscera is a well-known phenomenon, spontaneous rupture into the duodenum is rare. Moreover, no reports of upper gastrointestinal bleeding caused by pseudocyst rupture in patients under anticoagulation therapy for venous thrombosis associated with acute pancreatitis have been published. Herein, we report a unique case of massive upper gastrointestinal bleeding due to pancreatic pseudocyst rupture into the duodenum, which developed during anticoagulation therapy for portal vein thrombosis associated with acute pancreatitis.

Keywords: Pancreatitis; Pancreatic pseudocyst; Portal vein; Venous thrombosis; Warfarin