Mesenteric venous infarction in acute pancreatitis.

Segmental intestinal necrosis is a rare complication of acute pancreatitis. The pathogenesis of intestinal necrosis in acute pancreatitis has previously been attributed to arterial thrombosis, but we have observed an unusual case of segmental small intestinal infarction associated with pancreatitis that could not be explained by this mechanism. In our patient, the clinical, gross, and microscopic features were compatible with mesenteric venous infarction. A search of the literature revealed three previous cases of small intestinal infarction in patients with acute pancreatitis with similar clinical and histologic findings. Mesenteric venous infarction of the colon has also been described in association with acute pancreatitis. It seems clear that mesenteric venous infarction represents an additional cause of intestinal necrosis in patients with acute pancreatitis, and may result from changes in clotting mechanisms known to be induced by acute pancreatitis.