Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis

Abstract

AIMTo investigate the incidence and risk factors of portosplenomesenteric vein thrombosis (PSMVT) in the early stage of severe acute pancreatitis (SAP).METHODSPatients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography (CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic (ROC) curve was generated for the qualifying independent risk factors.RESULTSTwenty-five of the one hundred and forty (17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis (AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar’s CT severity index (CTSI) scores [odds ratio (OR): 2.742; 95% confidence interval (CI): 1.664-4.519; P = 0.000], hypoalbuminemia (serum albumin level < 25 g/L) (OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening (OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar’s CTSI scores was 0.777 (P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.CONCLUSIONHigh Balthazar’s CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.

Prevalence of portal vein thrombosis detected by computed tomography angiography in dogs

“…A previous case series evaluating four dogs with ultrasonographically detected portal vein thrombosis diagnosed one dog with pancreatic necrosis at post-mortem examination and linked pancreatitis as a possible cause in a second dog (Lamb et al 1996). Pancreatitis has also been previously connected to the development of portal vein thrombosis in cats and humans, with venous thromboses detected in up to 57% of humans with necrotizing pancreatitis (Dorffel et al 2000, Rogers et al 2008, Ding et al 2018. Pancreatitis is the most common exocrine pancreatic disorder in dogs (Hess et al 1998, Cook et al 1993, Xenoulis 2015, Jaeger et al 2003, Adrian et al 2015, Watson 2015.…”

Early-phase vascular involvement is associated with acute pancreatitis severity: a magnetic resonance imaging study

“…The mean time for the detection of portosystemic thrombosis after diagnosis in AP patients differs across imaging modalities. Recently, Ding et al (25) found the mean time for portosplenomesenteric thrombosis to be detected by CT was about 6 days; however, because their study only enrolled patients in the early phase of pancreatitis, this duration may have been shortened artificially. Our results are similar to those of Dörffel et al (26), who reported that portal venous thromboses were demonstrated by ultrasonography at an average time of 10-14 days (range, 3 days to 7 weeks) after diagnosis.…”

Laparoscopic Transgastric Necrosectomy in Treatment of Walled-off Pancreatic Necrosis with Sinistral Portal Hypertension: A Single-Center Retrospectively Study

“…However, we believed percutaneous drainage should be performed immediately once infection was considered. Splanchnic(SVT) or portosplenomesenteric (PSVT) venous thrombosis was not rare complication after acute pancreatitis with the incidence of 16.6-25.5%, which might result in sinistral portal hypertension [17,18]. Previous studies have clearly demonstrated the risk factors, including red blood cell speci c volume(HCT), D-dimer, serum amylase, APACHE-II score, and Ranson sore, for SVT or PSVT [19,20].…”