S3333 A Rare Presentation of Simultaneous Splenic Artery and Splenic Vein Thrombosis in Chronic Pancreatitis Leading to Hemoperitoneum and Emergent Splenectomy

Abstract

INTRODUCTION: Splenic complications in acute and chronic pancreatitis are very rare events, with the incidence of splenic vein thrombosis alone estimated to be approximately between 5-12%. CASE DESCRIPTION/METHODS: Here we present the case of a 32 year old female with chronic pancreatitis and a known fluid collection in the pancreatic tail who presented with altered mental status due to a combination of suspected ingestion and starvation ketosis. She had a complicated hospital course requiring intubation, continuous renal replacement therapy, vasopressor-dependent undifferentiated shock, an incidentally found patent foramen ovale, and right brachial vein deep venous thrombosis treated with IV heparin. During her course, she developed unrelenting left upper quadrant abdominal pain. On imaging, she was noted to have acute on chronic pancreatitis, along with splenic artery and venous thrombosis, which resulted in subsequent splenic infarct and splenic rupture with hemoperitoneum. This required emergent exploratory laparotomy and splenectomy. DISCUSSION: This case is rare not only for the complication of splenic vein thrombosis and infarct leading to splenic rupture, but for the simultaneous presentation of both splenic artery thrombosis and splenic vein thrombosis. The unique anatomic relationship of the splenic hilum in association with the pancreatic tail contributes to the wide variety of splenic pathologic complications as seen in this case. This case calls to mind the need for further exploration of arterial thrombosis in chronic pancreatitis, the role of anticoagulation as a possible prevention measure in chronic pancreatitis, and the need for prompt recognition of splenic complications in complex chronic pancreatitis patients.