Ewha Med J.  2014 Sep;37(2):116-120. 10.12771/emj.2014.37.2.116.

Portal and Splenic Vein Thrombosis Successfully Treated with Anticoagulants in Acute Pancreatitis

• Seong JS
• Song JH
• Cho KP
• Lee JS
• Woo YM
• Jeong BJ
• Cho YJ
• Han YJ

• KMID: 2171294
• DOI: http://doi.org/10.12771/emj.2014.37.2.116

Abstract

Splanchnic vein thrombosis arising from complications of acute pancreatitis is very rare. It usually occurs as a form of portal, splenic and superior mesenteric vein thrombosis, either in combination or separately. It could develop portal hypertension, bowel ischemia and gastrointestinal variceal bleeding. Treatment of splanchnic vein thrombosis includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery and liver transplantation. In some cases, anticoagulation therapy may be considered to prevent complications. However, the standard protocol for anticoagulation in splanchnic vein thrombosis has not been determined yet. We report a case of 43-year-old man who had portal and splenic vein thrombosis in acute pancreatitis. The patient was successfully treated with oral anticoagulants following low molecular weight heparin therapy.

Keyword

Portal vein thrombosis; Splenic vein thrombosis; Pancreatitis; Anticoagulants

MeSH Terms

Adult
Anticoagulants*
Esophageal and Gastric Varices
Heparin, Low-Molecular-Weight
Humans
Hypertension, Portal
Ischemia
Liver Transplantation
Mesenteric Veins
Pancreatitis*
Splenic Vein*
Thrombosis*
Veins
Venous Thrombosis
Anticoagulants
Heparin, Low-Molecular-Weight

Figure

• 

  Fig. 1 Computed tomography (CT) findings on admission. (A) Axial CT image shows necrotic changes in the pancreatic tail, fluid collections in the peripancreatic space (arrowheads) and portal vein thrombosis (arrow). (B) Coronal CT image shows portal vein thrombosis extension to splenic vein (arrow).

• 

  Fig. 2 Follow-up computed tomography (CT) findings 7 days later. (A) Axial CT shows no improvement of acute pancreatitis (arrowheads) and the new appearance of left portal vein thrombosis (arrow). (B) Coronal CT shows the new appearance of left portal vein thrombosis (arrow).

• 

  Fig. 3 Follow-up computed tomography (CT) findings 3 months later after anticoagulation. (A, B) CT findings show complete dissolution of portal and splenic vein thrombosis and great improvement of acute pancreatitis.

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