Vascular Complications in Acute Pancreatitis Assessed by Color Duplex Ultrasonography

Abstract

We determined the sensitivity of computed tomography and color duplex ultrasonography in the detection and characterization of vascular complications in acute pancreatitis. The relationship of these complications with the etiology and activity of the disease was assessed. In a prospective study, 189 patients with acute pancreatitis seen in the Department of Gastroenterology. Charité Hospital in Berlin over a period of 38 months underwent color duplex ultrasonography every second day for 3 weeks and thereafter at least once a week for 2 months. Dynamic computed tomography was performed within 72 hours after admission, and follow-up computed tomography scans were obtained. In 45 patients (23%), at least temporary thromboses of portal venous vessels were demonstrated by color duplex ultrasonography. The incidence of venous thromboses was 30% in severe acute pancreatitis with fluid collections without necroses and 57% in necrotizing pancreatitis. In 27 of those 45 patients, a formation of collaterals was documented. In 13 patients, arterial pseudoaneurysms were demonstrated. Vascular complications were significantly more frequent in alcohol-induced than in gallstone-induced pancreatitis. Only 62% of all sonographically diagnosed thromboses and only 32% of all collaterals were demonstrated by computed tomography. The prevalence of vascular complications in acute pancreatitis was much higher as suspected. The risk of gastrointestinal bleeding was lower than previously reported. Color duplex sonography is the method of choice for the detection of vascular complications in acute pancreatitis.

Portal Vein Thrombosis

“…49,50 Transient PVT has been reported in 23% of patients with acute pancreatitis and 57% in those with pancreatic necrosis. 51 PVT may also occur with Budd-Chiari syndrome mainly due to stagnant portal venous flow and an underlying prothrombotic state. 52 Recently thrombosis of the portal and mesenteric veins has been described presenting as a medical emergency in troops posted at high altitudes in India.…”

Role of Thrombophilia in Splanchnic Venous Thrombosis in Acute Pancreatitis

“…The reported incidence of SVT in previous studies ranged from 1.8-36.5% [6][7][8][9][17][18][19]. In our cohort of 96 patients, SVT was found in 26 (27.1%) patients.…”

“…Though the need for percutaneous catheter drainage was more common in patients with SVT compared to those without SVT, the difference did not reach the statistical significance. Earlier studies have reported that patients with SVT have longer hospital stays compared to those without [6][7][8][9][17][18][19]. Mortality as a direct consequence of SVT has not been reported in patients with AP, although SVT has a high mortality outside the setting of AP [21,22].…”

“…There is wide variation in the incidence of SVT in AP between different studies, with reported frequencies ranging from as low as 1.8% to as high as 36.5% [6][7][8][9]. Several studies have looked at the pathophysiological mechanisms associated with SVT [8][9][10].…”

Hepatic Infarction Complicated with Acute Pancreatitis Precisely Diagnosed with Gadoxetate Disodium-enhanced Magnetic Resonance Imaging

“…Pancreatitis may induce a spectrum of venous and arterial vascular complications (1)(2)(3)(4). For instance, venous thrombosis is caused by stasis, spasm, and mass effects from the surrounding inflamed pancreas, as well as by direct damage of the venous wall by liberated enzymes (2,5).…”