A study of splanchnic vein thrombosis in cases of acute pancreatitis and its outcome in a tertiary care center

Abstract

Splanchnic veins thrombosis(SVT) is one of the rare but known complications of Acute Pancreatitis(AP). It mostly involves Splenic vein(SPV), Superior mes enteric vein(SMV) and often Portal vein(PV) either individually or in combination. Though the cause is thought to be multi-factorial, a direct inflammatory process is implicated in the pathogenesis of SVT in AP. SVT can be sometimes an incidental finding in the radiological evaluation, but it also presents with severe pain, portal hypertension, hepatic dysfunction and bowel ischemia in a life-threatening scenario. Present study aims at understanding incidence, pattern, therapy initiated, complications and outcome of SVT in AP.A serial study of 89 cases of acute pancreatitis who underwent Contrast Enhanced Computed Tomography was conducted at tertiary care centre, department of general surgery, Mysore Medical College and Research Institute, Mysore, Karnataka from the period of January 2021 to June 2021. Out of 89 cases studied, 62 were male, 27 were female with mean age of 39.5 years. Most common cause of AP was Ethanol abuse, followed by Gallstones, Main pancreatic duct (MPD) anamoly, Anamoly of duodenal papillae and idiopathic. 37(41.57%) Patients had SVT. 31(83.78%) were male, 6 (16.22%) were female. 29 patients received anti-coagulation therapy, out of which 24 showed good response. Out of 8 patients who didn’t receive therapy 3 showed reduction in size of clot by 75%. Hence, anticoagulation has a therapeutic role in treatment of SVT (p- 0.0157). SVT is one of the known complications in AP with increase in incidence severity and with presence of peripancreatic collection. Spontaneous resolution of SVT is seen in about 40% of patients whereas anticoagulation therapy has a good role.