Management of chronic calcific pancreatitis with sinistrial portal hypertension – A retrospective study

Abstract

Objectives: Left sided or sinistrial portal hypertension is one of the vascular complications in Chronic calcific pancreatitis patients. The aim of this study was to analyse the clinical presentation, management and outcomes of this complication in a tertiary care centre. Methods: This is a retrospective study of 154 patients with Chronic calcific pancreatitis between Aug 2010 to May 2015. Out of 154 cases 16 (10%) had sinistrial portal hypertension. The male:female ratio was 3:1. The factors analysed were Demographic profile, clinical presentation, investigation, management modalities, perioperative morbidity and mortality. Results: The average age was 34.5 years. 12 patients were alcoholics. One patient had Jaundice, Three had Upper GI bleeding and five had steatorrhoea. All had abdominal pain radiating to back with pain score between 8 and 9. Two patients had small duct disease. Four of them had fundal varices on OGD. Out of 16 patients, 12 were treated with Frey s procedure and splenectomy, 2 were treated with Lateral pancreaticojejunostomy with splenectomy and 2 were treated with Izbiki procedure with splenectomy. One patient required Choledochodudenostomy for jaundice along with Frey's. Average duration of surgery was 200 minutes with mean blood loss 240 ml. Eleven patients required blood transfusion. The followup period was 3–57 months. None of them had UGI bleed in the followup period. Conclusion: Concomitant splenectomy should be strongly considered in patients undergoing operative treatment of symptomatic chronic pancreatitis with sinistral portal hypertension. Adding splenectomy to the pancreatic procedure did not increase morbidity or mortality.