Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8968
Peer-review started: February 6, 2022
First decision: April 10, 2022
Revised: April 19, 2022
Accepted: July 20, 2022
Article in press: July 20, 2022
Published online: September 6, 2022
Processing time: 200 Days and 17.4 Hours
Gallstone disease (GD) can have prolonged, subacute inflammatory period before biliary events. The intricate relationship between GD and inflammatory processes can possible lead to prothrombotic tendency that can result in confusing clinical course before diagnosis.
A 51-year-old man, presented with a 1-year history of self-relief occasional postprandial upper abdominal pain, had sudden onset severe left upper quadrant pain and visited our emergency room. Contrast enhanced computed tomography (CECT) showed filling defect in celiac trunk, common hepatic, part of splenic arteries and wedge-shaped hypo-enhancing region of spleen, consistent with splenic infarction secondary to splenic arterial occlusion. No convincing predisposing factors were found during first hospitalization. Abdominal pain mildly subsided after low molecular weight heparin and bridge to oral anticoagulant use. However, in the following six months, the patient was admitted twice due to acute cholangitis and finally cholecystitis. Second CECT revealed biliary impacted stone was adjacent to poor dissoluble thrombus. The abdominal pain did not achieve a clinical full remission until endoscopic retrograde cholangiopancreatography stone removal and series laparoscopic cholecystectomy was performed.
This is the first case to present serious thrombotic complication due to inflammation status in chronic GD. It could be a rare, confusing and difficult recognizing cause of a celiac trunk thro
Core Tip: We present a case of a gallstone-associated thromboembolic event and highlight the clinical course with difficulty of recognizing the predisposing factor. Recent studies have shown a bidirectional relationship between inflammation and perturbation of the coagulation process. This case highlights that gallstone-related local inflammation, even asymptomatic, can cause serious thromboembolic complications.