Splenic Vein Thrombosis: A Case Series of Consequential Chronic Pancreatitis and Sequential Myeloproliferative Disorder

Abstract

We present a case series of two patients with splenic vein thrombosis (SVT), a relatively uncommon condition supposed to occur in the context of pancreatitis or pancreatic malignancies. Splenic vein thrombosis may also be seen in cases of chronic pancreatitis, as in one of our patients. At times, splenic vein thrombosis may present with an incidental, isolated finding of gastric varices on computed tomography pulmonary angiogram (CTPA) while investigating for pulmonary embolus; such a result should prompt further investigation to rule out associated splenic vein thrombosis in a sequence. We attempt to highlight the importance of performing a blood count and hematocrit, supplementary to a liver screen, in another patient where the cause was not related to liver disease, but to myeloproliferative disorder, which resulted in a hyper-thrombotic state and splenic vein thrombosis as a consequence.

Systemic Thrombolysis for Isolated Splenic Vein Thrombosis Secondary to Oral Contraceptives: A Case Report

“…Thus, we have reviewed cases of ISVT or splenic vein occlusion in Table 1. 5, Pancreatic diseases should be the most common risk factors associated with ISVT, followed by tumors, infections, and hematological diseases. A potential mechanism of ISVT is that inflammatory reaction and extravascular…”

“…3 By comparison, isolated splenic vein thrombosis (ISVT) without involvement of portal vein and superior mesenteric vein is usually observed in patients with pancreatic diseases, especially pancreatitis and pancreatic cancer. 4,5 This is because the splenic vein lies posterior to the pancreas and extends along the tail and neck. More than half of the patients with ISVT present with abdominal pain, followed by gastric variceal bleeding.…”

Mechanisms linking hypertriglyceridemia to acute pancreatitis

“…Excluding "autoimmune" and "IgG4" reduces this to 22 reviews and reports of pancreatic involvement by the tumor-associated with hyperglobulinemia, and no clear association with pancreatitis. Similarly, literature searches do not show evidence of "polycythaemia" leading to "pancreatitis," since the case reports retrieved on PubMed using these search terms showed polycythaemia to follow pancreatitis, 110 local vascular complications from pancreatitis, 111,112 and share common risk factors, including obesity hypoventilation syndrome. 113 Moreover, the inability of mineral oil to reproduce the deleterious effects of TG and FFA in the abovementioned ex vivo studies reduced the likelihood of viscosity contributing to HTG-AP.…”