Endovascular stent grafting for superior mesenteric vein erosion in necrotizing pancreatitis: A lifesaving intervention in a rare complication

Abstract

Vascular complications, though rare, significantly increase the morbidity and mortality associated with necrotizing pancreatitis (NP). While arterial pseudoaneurysms are well-documented, major venous injuries, particularly superior mesenteric vein (SMV) erosion, are exceedingly uncommon, with only 2 cases previously reported in the literature. We describe a 41-year-old male with severe necrotizing pancreatitis complicated by abdominal compartment syndrome, who developed acute, life-threatening hemorrhage due to pancreatic enzyme erosion of the SMV. Surgical attempts to control the bleeding were unsuccessful, and the hemorrhage was ultimately managed with endovascular stent grafting of the SMV. This case underscores the complexity of vascular injuries in pancreatitis and highlights the potential role of endovascular interventions, such as venous stent grafting, as life-saving procedures when conventional surgical techniques fail. Our case adds to the limited but growing body of evidence supporting the use of venous stenting for mesenteric venous injuries in NP.