Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia

Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient with AP due to hypertriglyceridemia (HPTG), which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

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P-P31 Splanchnic vein thrombosis in acute pancreatitis: Incidence, risk factors and long term outcomes

British Journal of Surgery ◽

10.1093/bjs/znab430.254 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

K Thejasvin ◽

Sara-Jane Chan ◽

Chris Varghese ◽

Wei Boon Lim ◽

Gemisha Cheemungtoo ◽

...

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Splenic Vein ◽

Bleeding Complications ◽

Splenic Vein Thrombosis ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis ◽

Incidence Risk ◽

Necrotising Pancreatitis

Abstract Background There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). Methods A retrospective review of AP admissions between 2018-2021 across North East England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored. Results 401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only. On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with >50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and >50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT . 58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy. Conclusions A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.

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Splenic vein thrombosis in patients with acute pancreatitis

International Journal of Gastrointestinal Cancer ◽

10.1007/bf02924412 ◽

1989 ◽

Vol 5 (2) ◽

pp. 117-121

Author(s):

Christopher Rogers ◽

Edward C. Klatt

Keyword(s):

Acute Pancreatitis ◽

Splenic Vein ◽

Splenic Vein Thrombosis ◽

Vein Thrombosis

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Isolated Splenic Vein Thrombosis Associated with Acute Pancreatitis

Korean Journal of Pediatric Gastroenterology and Nutrition ◽

10.5223/kjpgn.2009.12.2.221 ◽

2009 ◽

Vol 12 (2) ◽

pp. 221 ◽

Cited By ~ 1

Author(s):

Hyang Soon Song ◽

Noo Ri Yang ◽

So Hee Jin ◽

Kyeong Dan Choi ◽

Young Taek Jang

Keyword(s):

Acute Pancreatitis ◽

Splenic Vein ◽

Splenic Vein Thrombosis ◽

Vein Thrombosis

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Hydatid cyst of the pancreas causing both acute pancreatitis and splenic vein thrombosis

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0111 ◽

2018 ◽

Vol 100 (7) ◽

pp. e178-e180 ◽

Cited By ~ 2

Author(s):

O Ozsay ◽

F Gungor ◽

Serkan Karaisli ◽

Ibrahim Kokulu ◽

Osman Nuri Dilek

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Hydatid Cyst ◽

Splenic Vein ◽

Final Diagnosis ◽

Pathological Examination ◽

Preoperative Imaging ◽

Splenic Vein Thrombosis ◽

External Compression ◽

Vein Thrombosis

Hydatid cyst of the pancreas is a rarely seen entity even in endemic countries. Cyst may causes several symptoms due to external compression or fistulisation to pancreaticobiliary tract or small bowel. A 23-year-old female patient was referred with a complaint of abdominal pain. Preoperative imaging revealed an undefined cyst in the tail of pancreas. She underwent distal pancreatectomy and splenectomy, with a diagnosis of acute pancreatitis due to cystopancreatic duct fistula and also left-sided portal hypertension due to splenic vein thrombosis. Pathological examination reported a final diagnosis of hydatid cyst. To the best of our knowledge, coincidence of cystopancreatic duct fistula and splenic vein thrombosis due to pancreatic hydatid cyst has not previously been reported.

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Outcomes of Anticoagulation for Portal and/or Splenic Vein Thrombosis in Setting of Acute Pancreatitis

The American Journal of Gastroenterology ◽

10.14309/00000434-201710001-00011 ◽

2017 ◽

Vol 112 ◽

pp. S6

Author(s):

Wesley Anderson ◽

Blake Niccum ◽

Maithili Chitnavis ◽

Dushant Uppal ◽

Ann R. Hays

Keyword(s):

Acute Pancreatitis ◽

Splenic Vein ◽

Splenic Vein Thrombosis ◽

Vein Thrombosis

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Isolated splenic vein thrombosis as a complication of abdominal trauma in a 3-month-old girl

Pediatria i Medycyna Rodzinna ◽

10.15557/pimr.2021.0043 ◽

2021 ◽

Vol 17 (3) ◽

pp. 275-278

Author(s):

Agnieszka Szmigielska ◽

◽

Grażyna Krzemień ◽

Magdalena Maria Rogala ◽

Aleksandra Jakimów-Kostrzewa ◽

...

Keyword(s):

Abdominal Trauma ◽

Collateral Circulation ◽

Traffic Accidents ◽

Varicose Veins ◽

Splenic Vein ◽

Splenic Vein Thrombosis ◽

Vein Thrombosis ◽

Common Causes ◽

Fall From Height ◽

Splenic Size

Falls from heights and traffic accidents are the most common causes of splenic damage. Abdominal trauma can cause splenic rupture or splenic vein thrombosis. About 11–55% of children with splenic vein thrombosis develop collateral circulation, leading to gastric and/or oesophageal varicose veins. Venous thrombosis in children can be also caused by congenital factors associated with coagulation disorders. The paper describes a case of a 3-month-old girl who developed isolated splenic vein thrombosis after a fall from height. Laboratory and genetic findings excluded thrombophilia. A 3-month anticoagulant treatment was administered. Gradual reduction in splenic size and the development of collateral circulation were observed in subsequent ultrasound scans. The girl remains under the care of a surgical clinic. The presented case of an infant with splenic vein thrombosis draws attention to possible complications of abdominal trauma after a fall from height.

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