Splanchnic vein thrombosis in severe acute pancreatitis: a 2-year, single-institution experience

Abstract

Splanchnic vein thrombosis is a relatively common observation in severe AP and is associated with pancreatic necrosis and peripancreatic collections. Recanalization is observed in almost a third of patients, irrespective of whether or not they receive systemic anticoagulation.

Role of Thrombophilia in Splanchnic Venous Thrombosis in Acute Pancreatitis

“…The superior mesenteric vein was the least common vessel to be involved, with thrombosis observed in only 4 (15.3%) patients. This pattern of vascular involvement is consistent with previous studies [8,9]. Almost all the previous studies reported the splenic vein to be the most commonly involved vessel.…”

“…Pleural effusion was also seen in a significantly greater number of patients with SVT, which may be related to a higher degree of local inflammation in AP patients with pleural effusion. Pancreatic and peri-pancreatic necrosis and the associated inflammatory process cause vascular inflammation and infiltration of vessels by inflammatory cells, inducing stasis leading to thrombus formation [8,9]. In our study, consistently with this hypothesis, the presence of necrotizing pancreatitis was significantly associated with a greater probability of developing SVT.…”

“…The reported incidence of SVT in previous studies ranged from 1.8-36.5% [6][7][8][9][17][18][19]. In our cohort of 96 patients, SVT was found in 26 (27.1%) patients.…”

“…There is wide variation in the incidence of SVT in AP between different studies, with reported frequencies ranging from as low as 1.8% to as high as 36.5% [6][7][8][9]. Several studies have looked at the pathophysiological mechanisms associated with SVT [8][9][10]. Factors that have been implicated are pancreatic and peripancreatic edema, inflammatory cellular infiltration, direct injury to blood vessels and fluid collection compressing the vessels and causing stasis of blood flow.…”

“…Moreover, there is a paucity of literature on the natural history of SVT in AP, with the majority of studies reporting that complications directly related to SVT are infrequent and that most of the patients remain asymptomatic with regard to splanchnic vein thrombosis [8,9]. In addition, spontaneous recanalization of a thrombosed splanchnic venous system has been reported in up to 30% of patients [15].…”