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Journal of Medical Case Reports

, 9:213

First Online: 17 September 2015Received: 05 February 2015Accepted: 21 August 2015DOI: 10.1186-s13256-015-0688-3

Cite this article as: Liao, CY., Huang, SC., Lin, CH. et al. J Med Case Reports 2015 9: 213. doi:10.1186-s13256-015-0688-3


IntroductionSymmetrical peripheral gangrene is an uncommon but devastating complication in critically ill patients, and it has a high mortality. It is seen in a wide variety of medical conditions, presenting as symmetrical gangrene of two or more extremities without large blood vessel obstruction.

Case presentationWe report a case of a 44-year-old Chinese man who was diagnosed with alcohol-related severe acute pancreatitis and presented with systemic inflammatory response syndrome and intractable vomiting. On the fourth day of admission, the patient developed cyanosis and gangrene of the fingers bilaterally. His cyanosis and gangrene did not resolve despite tapering of the vasopressor treatment. Gradually, his digital gangrene improved after administration of anti-platelet medication and pentoxifylline.

ConclusionsTo the best of our knowledge, this is the first case report of symmetrical peripheral gangrene occurring after acute pancreatitis with successful resolution. We highlight the importance of prompt and aggressive fluid resuscitation and consideration of multiple treatment options to prevent a hypovolemic state caused by acute pancreatitis.

KeywordsLow volemic state Severe acute pancreatitis Symmetrical peripheral gangrene SPG AbbreviationsAFPα-fetoprotein

ANAanti-nuclear antibodies

c-ANCAcytoplasmic anti-neutrophil cytoplasmic antibodies

aPTTactivated partial thromboplastin time

C3complement component 3

C4complement component 4

CA 19-9carbohydrate antigen 19-9

CEAcarcinoembryonic antigen

DICDisseminated intravascular coagulation

ESRerythrocyte sedimentation rate


HBsAghepatitis B surface antigen

HCVhepatitis C virus


INRinternational normalized ratio

PSAprostate-specific antigen

PTprothrombin time

RPR-VDRLrapid plasma regain-venereal disease research laboratory

SIRSSystemic inflammatory response syndrome

SPGSymmetrical peripheral gangrene

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Autor: Chen-Yi Liao - Shih-Chung Huang - Cheng-Hui Lin - Chih-Chiang Wang - Mei-Yu Liu - Ren-Jy Ben - Wu-Hsien Kuo - Ching-Chang 


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