Vascular Complications in Pediatric Pancreatitis: A Case Series

Dike, Chinenye R.; Cress, Gretchen A.; Fishman, Douglas S.; Gonska, Tanja; Ooi, Chee Y.; Perito, Emily R.; Troendle, David M.; Tsai, Cynthia M.; Lowe, Mark E.; Uç, Aliye

doi:10.1097/mpg.0000000000003218

Cited by 7 publications

(13 citation statements)

References 20 publications

(35 reference statements)

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“…Some authors argue that these thromboses occur as part of the inflammatory process during an episode of pancreatitis, and the thromboses will spontaneously recanalize when the acute inflammation has resolved. They report similar recanalization rates in their patients who had pancreatitis-associated splanchnic venous thrombosis treated with anticoagulants and those who did not have anticoagulant intervention [ 2 , 4 , 5 , 7 , 13 ]. Additionally, a recent meta-analysis concluded that there is no evidence to encourage routine use of anticoagulants in patients with splanchnic venous thrombosis associated with pancreatitis and that prospective studies are needed [ 13 ].…”

Section: Discussionmentioning

confidence: 88%

“…We report 2 cases of children with pancreatitis-associated splenic vein thrombosis occurring during moderately severe to severe AP attacks that were successfully managed with oral anticoagulants. Splanchnic vein thrombosis is a known but unusual complication of pancreatitis in children, with a reported incidence of only 1.2% in the INSPPIRE cohort [ 7 ]. The splenic vein is the most common vein involved.…”

Section: Discussionmentioning

confidence: 99%

“…In a single-center case series of 72 pediatric patients, 15.4% of patients with AP developed splanchnic venous thrombosis, compared to 0% of CP patients [ 6 ]. Additionally, in the largest multicenter cohort for pediatric acute recurrent pancreatitis (ARP) and CP (International Study Group of Pediatric Pancreatitis: In Search for a CuRE), out of 410 children in the cohort, vascular complications were mostly reported in moderately severe or severe AP but only reported in 1.2% of the cohort [ 7 ]. The benefit of anticoagulant use to prevent or treat pancreatitis-associated splanchnic vein thrombosis is yet to be validated in the literature [ 2 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The best type of anticoagulant to use is also not known. While there are multiple reports and observational studies on anticoagulant use for splanchnic thrombosis associated with acute pancreatitis in adults [ 2 , 5 , 8 ], pediatric data are limited to a few case reports and case series [ 6 , 7 , 9 ]. Venous thrombosis in children was traditionally treated with LMWH until a recent FDA approval of use of oral anticoagulants in children following a large clinical trial [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

et al. 2022

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Case series Patients: Female, 13-year-old • Female, 9-year-old Final Diagnosis: Pediatric acute recurrent pancreatitis • splanchnic venous thrombosis involving the splenic vein Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology Objective: Unusual clinical course Background: Splanchnic venous thrombosis is a known complication of pancreatitis in children and can involve the splenic, portal, or superior mesenteric veins, either in isolation or in combination. However, diagnosis and management of thrombosis following pancreatitis remains controversial, especially regarding the use of anticoagulants for management. Here, we present the cases of 2 children who developed splanchnic vein thrombosis involving the splenic vein during attacks of pancreatitis and who were successfully treated with direct oral anticoagulants. Case Reports: Case 1: A 13-year-old girl presented with a second attack of acute pancreatitis. She developed a non-occlusive splenic vein thrombosis diagnosed by CT scan on the sixth day of hospitalization. Injectable low-molecular-weight heparin was started during hospitalization and switched to oral rivaroxaban at discharge. Imaging at follow-up showed resolution of thrombosis. Case 2: A 9-year-old girl with history of acute recurrent pancreatitis presented with a third attack of acute pancreatitis. An occlusive splenic vein thrombosis with extension into the portal vein and superior mesenteric vein and necrotizing pancreatitis was seen on CT scan on the third day of hospitalization. Low-molecular-weight heparin was initiated during hospitalization and was switched to oral rivaroxaban at discharge. Imaging at follow-up demonstrated nearly complete resolution of the extensive thrombosis. Conclusions: Splanchnic venous thrombosis remains a rare complication of pediatric pancreatitis. Anticoagulant use in patients with these complications remains controversial. Direct oral anticoagulants are as safe and effective as low-molecular-weight heparin and should be considered for use in children instead of low-molecular-weight heparin due to its advantages, including the availability of enteral forms of administration.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

et al. 2022

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“…Vascular complications of acute pancreatitis (AP) include pseudoaneurysm-induced hemorrhage, ischemic complications, and hypercoagulability-induced venous thrombosis [ 1 ]. In pediatric AP, these complications are rare, and treatment experience is limited [ 2 ]. Although there are several reports of endovascular embolization for pseudoaneurysms or anticoagulation for venous thrombosis, evidence for the role of total pancreatectomy (TP) to control these complications has been rarely discussed.…”

Section: Introductionmentioning

confidence: 99%

Adolescent Acute Pancreatitis Complicated With Pseudoaneurysms and Venous Thrombosis

Wada¹,

Matsumoto²,

Sai³

et al. 2023

Cureus

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Vascular complications, such as pseudoaneurysms and thrombosis, are uncommon in pediatric acute pancreatitis (AP); hence, treatment experience remains limited. Here, we report a case of adolescent AP complicated with pseudoaneurysms and venous thrombosis simultaneously. Even after multiple endovascular embolizations for pseudoaneurysms, the patient experienced hemorrhagic shock resulting from pseudoaneurysm rupture after taking anticoagulants for thrombus. Inevitably, a total pancreatectomy was performed to prevent bleeding and control local complications. In AP, even among the pediatric population, a therapeutic dilemma between bleeding prevention and anticoagulation for thrombosis may occur. Despite the lack of experience with AP and its complications, a total pancreatectomy may become an alternative therapy for refractory AP or its complications.

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Multidisciplinary Approach to the Care of Children With Acute Recurrent Pancreatitis and Chronic Pancreatitis

et al. 2022

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ObjectivesThe aim of this article is to provide guidance to centers and organizations on the personnel (both physician and nonphysician) needed to create and sustain an optimal team, along with potential alternatives, to provide care to children with acute recurrent pancreatitis and chronic pancreatitis.MethodsThis document was developed in collaboration with the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Pancreas Committee and the National Pancreas Foundation (NPF) after several meetings.ResultsThis document highlights both physician and nonphysician personnel needed to provide multidisciplinary care to children with pancreatitis per the recommendation of the NASPGHAN Pancreas Committee members in year 2021 and added to the currently published NPF criteria. We summarize how the NPF criteria would fit with the recently published pediatric pancreatitis society articles from the NASPGHAN.ConclusionsIt is important to manage children with acute recurrent pancreatitis and chronic pancreatitis in a multidisciplinary setting. There is need to study the impact of these personnel on the outcomes of children with pancreatitis.

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Vascular Complications in Pediatric Pancreatitis: A Case Series

Abstract: Supplemental Digital Content is available in the text

Cited by 7 publications

References 20 publications

Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

Adolescent Acute Pancreatitis Complicated With Pseudoaneurysms and Venous Thrombosis

Multidisciplinary Approach to the Care of Children With Acute Recurrent Pancreatitis and Chronic Pancreatitis

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