Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3899-3906
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3899
Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report
Ling-Ling Yan, Xiu-Xiu Jin, Xiao-Dan Yan, Jin-Bang Peng, Zhuo-Ya Li, Bi-Li He
Ling-Ling Yan, Xiu-Xiu Jin, Xiao-Dan Yan, Jin-Bang Peng, Zhuo-Ya Li, Bi-Li He, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Author contributions: Yan LL wrote the draft; Jin XX, Yan XD, Peng JB and Li ZY contributed to clinical data collection and follow up; He BL critically revised the manuscript; and all authors contributed to the article and approved the submitted version.
Supported by Taizhou Science and Technology Grant, No. 1801ky68.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bi-Li He, MD, Chief Doctor, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, No. 150 Xinmen Street, Linhai 317000, Zhejiang Province, China. hebili1225@126.com
Received: August 30, 2021
Peer-review started: August 30, 2021
First decision: November 7, 2021
Revised: November 16, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 26, 2022
Processing time: 233 Days and 23.9 Hours
Abstract
BACKGROUND

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas characterized by self-digestion of pancreatic tissue, which can trigger a systemic inflammatory response. Venous thrombosis, resulting from a hypercoagulable state, is a vascular complication of AP. AP complicated by pulmonary embolism (PE) is very rare, and the combined use of extracorporeal membrane oxygenation (ECMO) with a vascular interventional procedure for AP complicated by PE is even rarer.

CASE SUMMARY

A 32-year-old man with a history of obesity developed rapidly worsening AP secondary to hypertriglyceridemia. During treatment, the patient developed chest tightness, shortness of breath, and cardiac arrest. Computed tomography (CT) scans of his upper abdomen were consistent with pancreatitis. PE was identified by chest CT angiography involving the right main pulmonary artery and multiple lobar pulmonary arteries. The patient’s D-dimer level was significantly elevated (> 20 mg/L). The patient received high-frequency oxygen inhalation, continuous renal replacement therapies, anti-infective therapy, inhibition of pancreatic secretion, emergent endotracheal intubation, and advanced cardiac life support with cardiopulmonary resuscitation. Following both ECMO and a vascular interventional procedure, the patient recovered and was discharged.

CONCLUSION

PE is a rare but potentially lethal complication of AP. The early diagnosis of PE is important because an accurate diagnosis and timely interventional procedures can reduce mortality. The combined use of ECMO with a vascular interventional procedure for AP complicated by PE can be considered a feasible treatment method. A collaborative effort between multiple teams is also vital.

Keywords: Acute pancreatitis; Pulmonary embolism; Extracorporeal membrane oxygenation; Respiratory distress syndrome; Case report

Core Tip: Acute pancreatitis (AP) complicated by pulmonary embolism (PE) is very rare and has a high mortality rate if not detected in time. We herein report a rare case of a 32-year-old male with AP complicated by PE. Following both extracorporeal membrane oxygenation and a vascular interventional procedure, the patient recovered and was discharged. We believe this paper describes a feasible treatment method for patients with PE, potentially aiding the clinical decision-making process.