Association of multiple splanchnic venous thrombosis and left renal venous thrombosis, a rare complication of pancreatitis: a\xa0case report

Youssef Motiaa,Houda Moumou,Zakaria Ouassou,Wafae El Otmani

doi:10.1186/s13256-019-2053-4

Youssef Motiaa, Houda Moumou + Show 2 more

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https://doi.org/10.1186/s13256-019-2053-4

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Abstract

BackgroundVascular complications of acute pancreatitis are common. Splanchnic thrombosis accounts for 11% of these complications, whereas extrasplanchnic thrombosis remains a rare entity. These complications are associated with high morbidity and mortality. Diagnosis is established on the basis of clinical and radiological evaluation, especially computed tomography. Renal vein thrombosis has been reported previously, but only in association with thrombosis of the inferior vena cava. To our knowledge, renal vein thrombosis without inferior vena cava thrombosis has never been reported in the literature. We report a case of a woman who developed acute pancreatitis complicated with splanchnic thrombosis and renal vein thrombosis with a patent inferior vena cava.Case presentationA 48-year-old Moroccan woman with no significant past medical history presented to our emergency department with worsening epigastric pain and vomiting. Her physical examination was notable only for moderate epigastric tenderness. She was apyrexic and had no jaundice or any features of liver failure. An initial computed tomographic scan showed Balthazar grade C pancreatitis with multiple splanchnic thromboses involving the portal vein, superior mesenteric vein, and left renal vein and enteromesenteric venous infarct with no signs of bowel perforation. The inferior vena cava was patent. Therapeutic anticoagulation and analgesia were started with resumption of enteral feeding 72 h later. The result of a thrombophilia screen was negative. Two months later, the patient was admitted to the intensive care unit with acute liver failure. Computed tomography of the abdomen showed worsening ischemic liver lesions and no signs of bowel perforation. Biochemical analysis showed acute hepatitis with hepatocellular insufficiency. The clinical evolution was unfavorable, and the patient died 48 h later.ConclusionsAssociation of splanchnic and renal vein thrombosis without inferior vena cava thrombosis as a complication of acute pancreatitis has never been reported before. There are no specific aspects of management of this complication; therapeutic anticoagulation and symptomatic treatment are the main measures used owing to the lack of available organs for liver transplant. The prognosis depends on the consequences of splanchnic thrombosis and their complications.

Highlights

Vascular complications of acute pancreatitis are common
Deep venous thrombosis (DVT), pulmonary embolism, and splanchnic thrombosis have been reported in the literature as complications of pancreatitis [2]
Vascular complications during pancreatitis are a major cause of morbidity and mortality [3]

Summary

Conclusions

Splanchnic venous thrombosis is a well-known complication of pancreatitis. It can be asymptomatic sometimes, but it can be responsible for higher mortality. Necessary investigations should be performed when pancreatitis is suspected. CT of the abdomen is used to assess the severity of pancreatitis, to detect local and vascular complications, and to assess their extrasplanchnic extension. Anticoagulant treatment in absence of contraindication can reduce mortality and recurrence of thromboses and can improve repermeabilization. The association of an extrasplanchnic localization does not change the management in absence of specific symptoms

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