Acute Pancreatitis Induced Splenic Vein Thrombosis

Abstract

Acute inflammation of the pancreas, known as pancreatitis, can result in many complications ranging from acute distress respiratory syndrome to pancreatic necrosis. A relatively common vascular complication of pancreatitis is splenic vein thrombosis (SVT) due to intimal inflammation leading to platelet aggregation and thrombosis. The management of SVT with regard to anticoagulation (AC) might appear to be perplexing at first given the recommendation to withhold any sort of AC. Research studies have shown that these patients have an increased risk of gastrointestinal bleeding without AC. In this report, we discuss a case of hypertriglyceridemia-induced pancreatitis. During hospitalization, our patient complained of worsening abdominal pain with objective fevers and leukocytosis in which CT scan of the abdomen was significant for hemorrhagic pancreatitis with necrosis, acute SVT, and splenomegaly. The patient was managed conservatively with IV fluids, pain relief medications, and antibiotics.

Acute Pediatric Pancreatitis Presenting with Splenic Vein Thrombosis

“…This becomes especially helpful in determining whether conservative management is clinically useful in selective patients [ 16 ]. Standard management also entails critical monitoring of the disease for complications that may develop during hospitalization [ 16 ].…”

“…This becomes especially helpful in determining whether conservative management is clinically useful in selective patients [ 16 ]. Standard management also entails critical monitoring of the disease for complications that may develop during hospitalization [ 16 ]. For example, SVT can increase venous pressure, which gives rise to portal hypertension and even further complications such as variceal bleeding [ 11 ].…”

“…This imposes a challenge in managing these patients, and whether to provide anticoagulants or not depends on the risk of gastrointestinal bleeding [ 11 ]. Additionally, some reports have determined splenomegaly as an asymptomatic sign of SVT that may require splenectomy before pancreatic surgery [ 16 ]. Based on the patient’s diagnostic tests, including imaging and laboratory results in the ED, she initially received conservative management with the administration of antiemetics, H2 blockers, IV opioids, and IV broad-spectrum antibiotics to address and manage her presenting symptoms on admission to the floor.…”

“…Routine anti-factor Xa levels were evaluated roughly four hours after the initial Lovenox dosage to provide optimal dosage and then were repeated throughout the treatment course. The goal of anticoagulation is to prevent the extension of the clot and to allow for recanalization so that intestinal infarction and portal hypertension do not develop [ 16 ]. Hematology was consulted to further optimize the treatment plan for our patient, in which restarting Lovenox was suggested and to be continued daily for one month.…”

“…The strategies have ranged from conservative management, such as treating acute pancreatitis, to bowel rest, anticoagulation, thrombolytics, and even surgery [11]. Many researchers have proven CT imaging to be statistically significant in the accurate prediction of pancreatitis severity and prevalence of SVT [16]. This becomes especially helpful in determining whether conservative management is clinically useful in selective patients [16].…”