A Case of Inferior Vena Cava Thrombosis and Acute Pancreatitis in a Patient with Ulcerative Colitis

Do Hyun Shin; Kwang Hyuk Lee; Chi Hoon Kim; Kap Hyun Kim; Sung Hyun Park; Dong Kyung Chang; Jong Kun Lee; Kyu Taek Lee

doi:10.4166/kjg.2010.56.4.255

Journal List > Korean J Gastroenterol > v.56(4) > 1006724

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Shin, Lee, Kim, Kim, Park, Chang, Lee, and Lee: A Case of Inferior Vena Cava Thrombosis and Acute Pancreatitis in a Patient with Ulcerative Colitis

Original Article

Korean J Gastroenterol 2010;56(4):255-259.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.4.255

A Case of Inferior Vena Cava Thrombosis and Acute Pancreatitis in a Patient with Ulcerative Colitis

Do Hyun Shin, M.D., Kwang Hyuk Lee, M.D., Chi Hoon Kim, M.D., Kap Hyun Kim, M.D., Sung Hyun Park, M.D., Dong Kyung Chang, M.D., Jong Kun Lee, M.D., Kyu Taek Lee, M.D.

Department of Internal Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

Correspondence to: Kwang Hyuk Lee, M.D. Department of Gastroenterology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: +82-2-3410-3409, Fax: +82-2-3410-3896 E-mail: kwanghyuck.lee@smc.samsung.co.kr

Received 13 May 2010 Accepted 11 June 2010

Abstract

A 21-year-old man admitted complaining of sudden severe epigastric pain for 1 day. He had been diagnosed as ulcerative colitis (UC) and taking mesalazine for two months. UC was in nearly complete remission at admission. He never drank an alcohol, and serum amylase was 377 IU/L. CT scan showed inferior vena cava (IVC) thrombosis in addition to mild acute pancreatitis. To evaluate the cause of acute pancreatitis and IVC thrombosis, magnetic resonance cholangiopancreatogram (MRCP), endoscopic ultrasonogram (EUS), lower extremity Doppler ultrasonogram (US) and blood test of hypercoagulability including factor V, cardiolipin Ab, protein C, protein S1, an-tithrombin III, and anti phospholipids antibody were performed. There was no abnormality except mild acute pancreatitis and IVC thrombosis in all the tests. He was recommended to stop taking mesalazine and start having anticoagulation therapy. After all symptoms disappeared and amylase returned normal, rechallenge test with mesalazine was done. Flare-up of abdominal pain occurred and the elevation of serum amylase was observed. Ulcerative colitis came to complete remission with short-term steroid monotherapy. Acute pancreatitis and IVC thrombosis were completely resolved after 3-month anticoagulation therapy with no more mesalazine. We postu-lated that IVC thrombosis occurred due to hypercoagulable status of UC and intraabdominal inflammation caused by mesalazine-induced pancreatitis.

Keywords: Ulcerative colitis, Inferior vena cava thrombosis, Acute necrotizing pancreatitis, Mesalazine

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Fig. 1.

Diffuse hyperemic edema, erythema, superficial ulcers with whitish exudates were observed during an initial colonoscopy (A). After two months, nearly complete remission was observed during admission due to acute pancreatitis (B).

Fig. 2.

Abdominal CT showed diffuse pancreatic swelling, peri-pancreatic infiltration with fluid collection and the fluid was ex-tended to the left anterior pararenal space. However, there was no other remarkable finding on the pancreatobiliary systems.

Fig. 3.

EUS examination and CT scan showed partially occluding thrombus (white arrows) in the IVC.

Fig. 4.

Severe abdominal pain and marked elevation of pancreatic enzyme was developed 1 day after a mesalazine was reade-ministered. His abdominal pain subsided and elevated pancreatic enzymes returned to normal after mesalazine was discontinued.

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