FTP6.10 Acute Pancreatitis complicated with splanchnic vein thrombosis; our 12 months experience

Abstract

Abstract Objectives Splanchnic vein thrombosis (SVT) is a relatively common observation in severe acute pancreatitis (AP) and is associated with pancreatic necrosis and peripancreatic collections. Currently, there is no consensus on whether patients presenting with splanchnic vein thrombosis in the setting of AP should receive therapeutic anticoagulation. We aimed to determine current practices in the management of splanchnic vein thrombosis complicating AP, in our hospital. Methods An audit of retrospectively collected data for all patients presenting with AP was conducted. Patients with splanchnic vein thrombosis were grouped according to vessel involvement and whether or not systemic anticoagulation was administered. Results Of 172 consecutive patients admitted with AP between January and December 2022, 10 had splanchnic venous thrombosis; in all cases, the thrombosis was associated with a severe attack of AP. Involvement of the splenic vein (SV), portal vein (PV) and superior mesenteric vein (SMV) was observed in 3, 2 and 3 patients, respectively. Involvement of more than one vessel was observed in two patients (SV and PV). The most common etiological factor for AP was alcohol. Seven patients received systemic anticoagulation with therapeutic LMWH initially, followed by oral DOAC for 3 months. No complications associated with systemic anticoagulation occurred. None of the patients developed liver failure, and we did not observe any fatal outcomes. Conclusions SVT represents a diagnostic and therapeutic challenge. Based on limited evidence, treatment decisions should be individualized with the evaluation of bleeding risks versus SVT recurrence or extension. Additional research is needed to further assist prompt management.