Concomitant Gastric and Duodenal Wall Necrosis as a Rare Late Complication of Severe Acute Pancreatitis: A Case Report

TL;DR

A rare case of gastric and duodenal wall necrosis occurring as a late complication of severe acute pancreatitis is reported, highlighting the importance of early diagnosis and intervention.

Contribution

This case report presents a rare late complication of severe acute pancreatitis involving both gastric and duodenal necrosis.

Findings

Non-enhancing posterior gastric and duodenal walls with intramural gas were observed via CECT, indicating ischemic and infected necrosis.

The patient developed multiorgan failure and died despite surgical debridement and intensive care.

Histopathology confirmed ischemic necrosis of both the gastric and duodenal walls.

Abstract

Severe acute pancreatitis (SAP) is a life-threatening inflammatory condition that can occasionally result in rare and devastating extra-pancreatic complications. Among these, gastric or duodenal wall necrosis is exceptionally uncommon but carries a high risk of mortality.

We report the case of a 56-year-old man with idiopathic SAP who initially improved with conservative management. After systematic exclusion of common etiologies, including biliary, alcoholic, metabolic, infectious, and drug-induced causes, the pancreatitis was classified as idiopathic. Three weeks after admission, he developed recurrent abdominal pain, fever, and hemodynamic instability. Contrast-enhanced computed tomography (CECT) revealed non-enhancing posterior gastric and duodenal walls with intramural gas, indicating ischemic and infected necrosis. Despite prompt surgical debridement, intensive care management, and broad-spectrum antibiotics, the patient developed multiorgan failure and subsequently died. Histopathology confirmed ischemic necrosis involving both the gastric and duodenal walls.

This case underscores the multifactorial pathogenesis of such complications, combining microvascular thrombosis, enzymatic vascular injury, and bacterial infection. Because gastric and duodenal necrosis often occur in the late phase of pancreatitis, sometimes after apparent recovery, their diagnosis can be delayed. Therefore, any recurrence of abdominal pain or systemic instability in SAP should prompt immediate imaging to rule out delayed ischemic complications. Early recognition and multidisciplinary intervention remain essential to improve outcomes in these rare but catastrophic manifestations of severe pancreatitis.

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