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

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.