Splenic and portal venous obstruction in chronic pancreatitis

Abstract

The aim of this study was a prospective search for splenoportal venous obstruction (SPVO) in a medical-surgical series of 266 patients with chronic pancreatitis who were followed up a mean time of 8.2 years. SPVO was systematically searched for using ultrasonography and then confirmed by angiography or computed tomography. SPVO was found in 35 patients (13.2%) but was symptomatic in only two. Initial obstruction involved the splenic vein in 22 patients, the portal vein in 10, and the superior mesenteric vein in three. Since venous obstruction extended from the splenic to the portal vein in five patients, the prevalence of portal obstruction was 5.6% (15/266). Acute pancreatitis and pseudocysts were the probable cause of SPVO in 91.4% of our cases. Half the cases of splenic venous obstruction were related to pseudocysts of the caudal pancreas. Esophageal varices were found in two patients and gastric varices in four at the time of diagnosis and during follow-up. At the end of follow-up, 12 patients had undergone splenopancreatectomy (N = 11) or splenectomy (N = 1). Only one patient was operated on for massive esophageal variceal bleeding, and another patient died due to intractable colic variceal bleeding. In four of six patients operated on with portal vein obstruction, surgery was difficult due to venous collaterals. Ten patients were not operated on and 13 patients operated on were not treated for SPVO. The mean follow-up after diagnosis of SPVO for these final 23 patients was 28.9 months. None of these patients bled.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular Complications in Chronic Pancreatitis

“…If there is the slightest index of suspicion for an active hemorrhage, we perform angiography after upper endoscopy including the inspection of the papilla of Vater in order to exclude hemorrhage through the papilla [12], The advantage of selective and superselect ive angiography in cases of emer gencies and in unstable patients in whom one may achieve an exact localization of the vascular lesion with the possibility of embolization and control of the active life-threatening hemorrhage enables to resuscitate the pa tient and prepare for operation if indicated [13,14], Nonbleeding vascular involvement, though a signifi cant clinical problem, is rarely appreciated despite the fact that venous compression/thrombosis may influence the strategy of treatment, especially in cases with long standing left-sided portal hypertension combined with gastric or esophageal varices [15][16][17][18]. Indeed, half of our patients with vascular complications (or 14% of all pa tients with chronic pancreatitis) demonstrated the non bleeding form of vascular involvement which reflects results obtained by others [19], Seventy-six percent of these lesions that were combined with pseudocyst forma tion were associated with a low to zero mortality and were rarely a direct indication of surgery.…”

Portal vein thrombosis – a primer for the general physician

“…This may be during a splenectomy or hepatectomy, insertion of a surgical shunt or any other surgical procedure in the vicinity of the portal vein. 12,15 Inflammation of any of the abdominal organs is another local factor; 16 this includes pancreatitis, cholecystitis, appendicitis and any other intra-abdominal infection. One study looking at 102 patients with non-cirrhotic non-malignant acute PVT showed local factors to be the cause in up to 21%; the most common of them being acute pancreatitis.…”

Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report

“…Moreover, different treatment options for gastric variceal bleeding secondary to splenic vein thrombosis have been proposed. Splenectomy was formerly considered the best treatment [11,14,15]. Endoscopic injection sclerotherapy in patients with GVs is more difficult to perform than when esophageal varices are involved [16].…”