Wu CY, Su CC, Huang HH, Wang YT, Wang CC. Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report. World J Clin Cases 2022; 10(25): 8968-8973 [PMID: 36157657 DOI: 10.12998/wjcc.v10.i25.8968]
Corresponding Author of This Article
Chi-Chih Wang, PhD, Assistant Professor, Director, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung 40201, Taiwan. bananaudwang@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 6, 2022; 10(25): 8968-8973 Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8968
Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report
Chia-Ying Wu, Chang-Cheng Su, Hsin-Hui Huang, Yao-Tung Wang, Chi-Chih Wang
Chia-Ying Wu, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
Chang-Cheng Su, Chi-Chih Wang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Chang-Cheng Su, Yao-Tung Wang, Chi-Chih Wang, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Hsin-Hui Huang, Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan
Yao-Tung Wang, Division of Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Author contributions: Wu CY and Su CC contributed equally to this work, and considered as co-first authors; Wu CY reviewed the literature and contributed to manuscript drafting; Su CC and Wang YT responsible for manuscript revision based upon the reviewers’ comments; Wang CC was the patient’s gastroenterologist, responsible for the revision and final approval of the manuscript; Huang HH is responsible for the interpretation of image in our article; and all authors issued final approval for the version to be submitted.
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: Chi-Chih Wang, PhD, Assistant Professor, Director, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung 40201, Taiwan. bananaudwang@gmail.com
Received: February 6, 2022 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
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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 thromboembolic event.
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.
