Splanchnic Venous Thrombosis Research Articles

JAK2 mutational status and the contribution of TERT and JAK2 polymorphisms to the occurrence of myeloproliferative neoplasms in Eastern Morocco

Background: The JAK2 V617F somatic mutation is a hallmark of myeloproliferative neoplasms (MPN) and is present in some patients with splanchnic venous thrombosis (SVT). Objectives: We investigated for the first time in Eastern Morocco the JAK2 mutational status and germline risk factors, such as the TERT and JAK2 polymorphisms, in MPN and SVT patients. Methods: This study included 38 patients with MPN, 24 patients presenting with SVT and 60 healthy donors from the BRO Biobank. JAK2 mutations were analyzed using qPCR and Sanger sequencing. Predisposing polymorphisms to MPN were evaluated using Sanger sequencing. Results: JAK2 V617F mutation was positive in 64.5% of patients with MPN and 20.8% of patients with SVT. The JAK2 V617F allelic burden ranged from 2% to 97.53%. We found a strong association between the JAK2 rs56241661 polymorphism of the JAK2 46/1 haplotype and the development of MPN. However, no association was detected between the TERT rs2736100 polymorpism and MPN. Conclusion: The JAK2 mutational status and its allelic burden in Eastern Morocco are consistent with previous studies. The JAK2 46/1 haplotype was strongly associated with MPN. However, unlike other previously studied populations, the TERT polymorphism rs2736100 has no effect on the occurrence of MPN in our population. Keywords: Myeloproliferative neoplasms; JAK2 V617F; TERT and JAK2 polymorphisms; genetic predisposition; Morocco.

Rescue Transsplenic Gastric Varices Embolization in a Patient of Massive Gastric Variceal Bleed Secondary to Complete Splanchnic Portal Venous System Thrombosis

AbstractEndoscopic sclerotherapy is the first-line modality to manage gastric variceal bleeding; however, knowledge of other treatment options is also essential, especially in case of failure of the endoscopic approach. We are reporting a rare case of successful rescue gastric varices embolization through the transsplenic route in a gastric varices bleeding patient who presented with massive hematemesis and blood from the ileostomy drain site secondary to complete splanchnic portal venous system thrombosis when all other treatment options were not feasible or unsafe. Proper cross-sectional imaging evaluation, knowledge of treatment options, and understanding of intraprocedural challenges are essential for managing gastric varices.

Risk factors and Nomogram Prediction for Splanchnic Venous Thrombosis in Moderate and Severe Acute Pancreatitis

BACKGROUND: Acute pancreatitis is one of the most common gastrointestinal diseases with significant morbidity and mortality, especially in the moderate to severe types. Splanchnic vein thrombosis(SVT) is related to acute pancreatitis but the pathogenesis of SVT in patients with AP is incompletely understood. AIM To investigate the risk factors of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) complicated by splanchnic venous thrombosis. METHODS The clinical data of 290 patients with MSAP and SAP admitted to Xuanwu Hospital of Capital Medical University between December 2015 and December 2020 were retrospectively analyzed. Patients were divided into two groups: 1) with thrombosis and 2) without thrombosis. Sex, age, etiology, severity of acute pancreatitis, platelet (PLT), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), prothrombin time (PT), activated partial thrombin time (APTT), D-dimer (D-D) levels, type of pancreatic necrosis, proportion and location of pancreatic parenchymal necrosis (PPN), location of local complications, computed tomography severity index (CTSI) and modified CTSI(mCTSI) were recorded. Univariate, logistic multivariate regression analyses and nomogram were used to determine the risk factors for splanchnic venous thrombosis complicated by acute pancreatitis (AP). A receiver operating characteristic (ROC) curve, decision curve and calibration curve were drawn. RESULTS Among 290 patients with AP, 71 (24.5%) had SAP, and 219 (75.5%) had MSAP. The median age of all the patients was 49 years; 172 patients (59.3%) had biliary disease, 91 patients (31.4%) had hypertriglyceridemia, 13 patients (4.5%) had alcohol disease, and 14 patients (4.8%) had other diseases. Of the 290 patients, SVT was detected in 35 (12.1%). Univariate analysis showed that the severity of acute pancreatitis, PLT, CRP, PCT, IL-6, PT, D-D, proportion of pancreatic parenchyma necrosis (PPN), necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space, CTSI and mCTSI in the thrombus group were all statistically significant (P < 0.05). The results of multivariate analysis showed that PLT≧422 × 109/L, necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space were independent risk factors for AP complicated with splanchnic venous thrombosis. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.845. CONCLUSION PLT≧422 × 109/L, necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space are independent risk factors for splanchnic vein thrombosis. A simple nomogram tool helps in the early, accurate prediction of AP. Early and relevant clinical intervention should be provided.

A316 ACUTE NECROTIZING PANCREATITIS COMPLICATED BY PULMONARY EMBOLISM: A CASE REPORT AND REVIEW OF LITERATURE

Abstract Background Acute pancreatitis (AP) is an inflammatory condition associated with local and systemic complications. Severe pancreatitis can include the development of peripancreatic fluid collections and necrotizing pancreatitis (NP). Vascular complications are one of the causes of morbidity and mortality in patients with AP. Splanchnic thrombosis has been well described in AP and can been seen in up to 24% of patients. Extra splanchnic vessel thrombosis, including pulmonary embolism (PE), is rare. Aims Describe a case of acute NP with peripancreatic fluid collection complicated with bilateral PE and review the relevant literature. Methods We performed a literature review for AP complicated by PE. Results Case: A 60-year-old man presented to the hospital with one day of abdominal pain, nausea and vomiting. His medical history was significant for obesity with a BMI of 40. He was not on any medications. He did not drink alcohol. On exam his heart rate was 58, blood pressure 149/94 mmHG, oxygen saturation was 95% on room air, he was afebrile. His abdomen was tender in the epigastric region. His labs revealed a white blood cell count of 14 x 109/L, lipase ampersand:003E 3,000 U/L, Bilirubin 40 umol/ L, AST 613 U/L, ALT 527 U/L, GGT 394 U/L, ALP 94 U/L, Creatinine 159 mmol/L. CT abdomen/pelvis revealed cholelithiasis without choledocholithiasis or biliary dilation. The pancreas was inflammed with necrosis throughout. There were two peripancreatic fluid collections (60mm x 41mm, and 148mm x 89mm). He was diagnosed with acute necrotizing pancreatitis thought secondary to gallstones. He was fluid resuscitated, started on antibiotics and unfractionated heparin (UFH) for deep vein thrombosis (DVT) prophylaxis. His oral intake remained low. Imaging on day 30 showed a large walled off necrotic collection (25cm x15cm). Vascular strucutres were patent. On day 36 he underwent endoscopic ultrasound guided drainage via lumen-apposing metal stent (LAMS). On day 43 he developed new tachycardia. CT chest revealed bilateral pulmonary emboli (Image 1). Doppler ultrasound revealed bilateral occlusive thrombus in the calf veins. He was treated with therapeutic UFH. Literature review: We identified 10 case reports describing AP complicated by PE. The age amonst reports was variable (21 to 68). 4 cases reported additional thrombosis outside of the pulmonary vasculature. No cases which described splanchnic venous thrombosis prior. 3 cases reported pancreatic necrosis. The use of DVT prophylaxis was not reported. There is one case of PE 2 days after LAMS insertion in a patient with known thromboembolic disease. Conclusions PE is a rare complication of AP. Novel to this case was the recent deployment of a LAMS, the significance of which is unknown to date. Improved documentation of variables in future reports is needed to further characterize this event. Image 1: Acute Pulmonary Embolism. Funding Agencies None

Superior mesenteric vein thrombosis due to COVID-19 vaccination: a case report

BackgroundThe worldwide vaccination response to COVID-19 has been associated with rare thrombotic complications, including the case of postvaccination splanchnic venous thrombosis we report here.Case presentationAn 80-year-old Japanese male with abdominal pain presented to our hospital six days after receiving a dose of the COVID-19 messenger ribonucleic acid vaccine. Abdominal computed tomography showed localized edema of the small intestine, increased density of the surrounding adipose tissue, and a thrombus in the superior mesenteric vein. Conservative inpatient treatment with unfractionated heparin relieved the thrombosis, and the patient is currently receiving oral apixaban as an outpatient.ConclusionReported cases of thrombosis after COVID-19 vaccination typically have been associated with viral vector vaccines, with few reports of thrombosis induced by mRNA vaccines. The potential for venous thrombosis should be explored when patients present with abdominal pain soon after COVID-19 vaccination.

Approach to the patient with non-cirrhotic splanchnic venous thrombosis: a brief narrative review.

Splanchnic venous thrombosis refers to the obstructive events of the abdominal venous system (portal, splenic, mesenteric, and suprahepatic) present with or without an underlying liver disease. These are rare disorders generally associated with both local risk factors, such as intra-abdominal infections, surgery or abdominal trauma, and systemic risk factors, represented by drugs (notably estrogen therapy) and some types of inherited or acquired thrombophilia, including myeloproliferative neoplasms associated with the V617F mutation of the JAK2 gene. The clinical presentation is heterogeneous, ranging from asymptomatic patients with incidental findings on abdominopelvic imaging to severe systemic compromise in sudden onset cases, with a high morbidity and mortality burden. Anticoagulation therapy is the current recommended treatment based on observational studies, with no consensus on management in the acute and long-term setting for both inmediate complications such as acute liver failure and intestinal ischemia or those arising from secondary portal hypertension over a longer period of time.

FcγRIIa - dependent platelet activation identified in COVID-19 vaccine-induced immune thrombotic thrombocytopenia-, heparin-induced thrombocytopenia, streptokinase- and anisoylated plasminogen-streptokinase activator complex-induced platelet activation.

Coronavirus disease 2019 (COVID-19), which was caused by the coronavirus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was globally responsible for remarkable morbidity and mortality. Several highly effective vaccines for COVID-19 were developed and disseminated worldwide within an unprecedented timescale. Rare but dangerous clotting and thrombocytopenia events, and subsequent coagulation abnormalities, have been reported after massive vaccination against SARS-CoV-2. Soon after their global rollout, reports of a morbid clinical syndrome following vaccination with adenovirus-DNA-based vaccines appeared. In the spring of 2021, reports of a novel, rare and morbid clinical syndrome, with clinically devastating and fatal complication after vaccination with adenovirus-based coronavirus vaccines (Janssen/Johnson & Johnson and Astra-Zeneca vaccines) led to a brief suspension of their use by several countries. Those complications were associated with unusual cerebral and splanchnic venous thrombosis, and circulating autoantibodies directed against anti-platelet factor 4 (PF4), a protein secreted from platelets, leading to the designation: Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT). The reported VITT incidence remains very low and does not affect the overall benefit of immunization, however, if left untreated, VITT can be debilitating or even fatal. VITT resembled specific adverse drugs' reactions that also involved the production of autoantibodies and subsequent abnormal platelet activation through platelet FcγRIIa. These unusual but well-documented drug reactions were heparin-induced thrombocytopenia (HIT), streptokinase- (SK), and anisoylated plasminogen-streptokinase activator complex- (APSAC) associated with platelet-activating antibodies. There was considerable overlapping of clinical features between VITT, COVID-19 and these adverse drugs' reactions. We review the phenomenon of VITT against the backdrop of shared and common mechanisms that underlie HIT-, SK-, and APSAC-platelet FcγRIIa-dependent platelet activation. An understanding of VITT's pathogenesis may be achieved by comparing and contrasting VITT-, HIT-, SK- and APSAC-induced platelet activation mechanisms, their respective physiopathology and similarities. Discussing these conditions in parallel provides insight into complex immunological disorders and diseases associated with abnormal hemostasis and thrombosis in particular.

Multiple Splanchnic Venous Thromboses: A Fatal Complication of Recurrent Pancreatitis

Splanchnic Venous Thrombosis (SVT) is a condition associated with high morbidity. The etiologies of SVT include intra-abdominal inflammation or infection, surgical intervention, abdominal malignancies such as hepatocellular carcinoma (HCC) and pancreatic carcinoma, or abnormality in coagulation caused by various reasons such as liver cirrhosis. Most cases of pancreatitis are mild and self-limited. On the other hand, approximately one-quarter of patients with pancreatitis may develop vascular complications such as venous thrombosis. Pancreatitis associated with vascular complications is dangerous and potentially fatal. The survival of patients with pancreatitis and vascular complications depends on the early detection of these complications. We report a case of a middle-aged male who had recurrent pancreatitis. On radiological imaging, the patient was found to have a portal vein, splenic vein, and superior mesenteric vein thrombosis. The etiology of thrombosis was considered to be inflammation around the main portal trunk caused by pancreatitis Patient recovered after emergent and timely management with initially low molecular weight heparin and bridged by oral apixaban therapy. The article focuses on the aspects of etiology, pathogenesis, diagnosis, and management of acute pancreatitis with venous thrombosis. J Rang Med Col. September 2023; Vol. 8, No. 2: 60-63

PB0965 Delphi Survey of Canadian Physicians to Determine Optimal Anticoagulant Treatment Approaches for Patients with Cancer and Splanchnic Venous Thrombosis

PB0965 Delphi Survey of Canadian Physicians to Determine Optimal Anticoagulant Treatment Approaches for Patients with Cancer and Splanchnic Venous Thrombosis

S3577 Transjugular Intrahepatic Portosystemic Shunt Creation for Mechanical Thrombectomy in a Non-Cirrhotic Patient with Extensive Splanchnic Venous Thrombosis

S3577 Transjugular Intrahepatic Portosystemic Shunt Creation for Mechanical Thrombectomy in a Non-Cirrhotic Patient with Extensive Splanchnic Venous Thrombosis

Outcomes in Patients with Liver Dysfunction Post SARS-CoV-2 Infection: What Should We Measure?

Since 2019, the COVID-19 pandemic wreaked havoc all over the world. Early in the course of the pandemic, multiple hepatic manifestations of COVID-19 were noted. We aim to categorize hepatic dysfunction and its outcome in COVID-19 infection. This is a review article based on a literature search in PubMed and Medline databases for articles detailing short-term and long-term outcomes of COVID-19 related liver dysfunction. The most common hepatic manifestation of COVID-19 was aspartate amino transferase (AST) predominant transaminase elevation. Transaminases improve once the COVID-19 infection resolves. In addition, COVID-19 cholangiopathy, autoimmune hepatitis associated COVID-19, and splanchnic venous thrombosis triggered by COVID-19 are other manifestations. Patients with preexisting liver disease, especially those with cirrhosis, have poor prognosis with COVID-19 infections compared to the general population. Elevations in liver tests were associated with severe COVID-19 infections. Patients with chronic liver disease have a higher risk of morbidity and mortality from COVID-19 infection. Among patients with chronic liver disease, decompensated liver cirrhosis, hepatocellular carcinoma and alcohol-associated liver disease were associated with an increased risk of severity and mortality from COVID-19 infection. Interactions between antiviral therapy for COVID-19 and hepatitis B/hepatitis C medications must be considered in patients with chronic viral hepatitis and COVID-19 infection. COVID-19 vaccination-related hepatic dysfunction has been reported. COVID-19 is here to stay. Hepatic dysfunction in COVID-19 signals severe COVID-19 infections. Patients with chronic liver disease have higher mortality from COVID-19 than general population. It is important to remember the lessons learned throughout the covid pandemic to take care of patients with COVID-19 now and in the future. Further studies are needed to document long-term outcomes in patients with COVID-19 who developed hepatic dysfunction.

1248 DELPHI Consensus Study - Splanchnic Venous Thrombosis in Acute Pancreatitis

Abstract Aim A DELPHI consensus process was conducted to identify new areas for research in the largely understudied territory of Splanchnic Venous Thrombosis (SpVT). The overarching purpose was to help establish at-risk patient subgroups, current expert therapeutic practices and key outcome measures of SpVT in the short-, medium- and long-term care of patients. Method Duration: 2021-2022. International pancreatitis experts designed Redcap software surveys following DELPHI consensus methodology. Stakeholder distribution was via international networks, extending outreach to SpVT experts from intensive care, pancreatology, and general/HPB surgical backgrounds, who work in tertiary centres worldwide. Question design targeted at-risk subgroups, optimal diagnostic and management modalities, and order-ranked outcomes. Blinded data analyses were performed using Redcap software. Results ROUND 1 n(respondents) = 73/153. ROUND 2 n(respondents) = 53/73. 75% of experts agree that SpVT increases mortality among patients with acute pancreatitis. By Round 2, there was overwhelming consensus that therapeutic anticoagulation was beneficial for Portal Vein SpVT (90.4%) and Superior Mesenteric Vein (92.3%) thromboses (SpVTs), provided there were no significant patient bleeding risk factors. No consensus was reached regarding duration of anticoagulation. Conclusions There exists significant heterogeneity for optimal duration of therapeutic anticoagulation to treat SpVT in acute pancreatitis. While consensus clearly suggests a role for therapeutic anticoagulation, this must achieve equipoise against risks. Our DELPHI process identified upper GI bleeding, liver ischaemia and bowel ischaemia as important outcomes of anticoagulation-based SpVT management for the short, mid- and long-terms of patient follow-up. Future DELPHI rounds will involve further enquiry into the optimal duration of anticoagulation for SpVT.

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

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.

Catheter-directed thrombolysis versus systemic anticoagulation in the treatment of symptomatic splanchnic venous thrombosis secondary to acute pancreatitis: a retrospective cohort study

BackgroundCatheter-directed thrombolysis (CDT) has been an important therapy and seems effective in patients with splanchnic venous thrombosis (SVT) secondary to some diseases, but this intervention hasn’t been formally evaluated in the setting of acute pancreatitis (AP).MethodsThis was a retrospective study enrolled patients between January 2013 and December 2018. AP patients who developed SVT-induced symptoms, including intractable ascites and/or enteral nutrition intolerance, were included. Demographics, SVT associated parameters, clinical features and outcomes, long-term quality of life evaluated by using SF-36 questionnaire were compared between CDT group and systemic anticoagulation (SAC) group.Results6 patients underwent CDT and 17 received SAC. Patients in CDT group had a higher recanalization rate (100% versus 35.3%; p = 0.014) and shorter time to symptoms resolution (median 8 days versus. 31.5 days, p = 0.004). Mortality and length of hospital stay were comparable between two groups. The association analysis indicated that CDT use exerted a significantly beneficial effect on recanalization rate (risk ratio, 2.833; 95% CI, 1.489 to 5.393; p = 0.002) and time to symptoms resolution (mean difference, -33.333; 95% CI, -64.612 to -2.055; p = 0.038). No SVT-related symptoms recurrence was recorded in survivors at six-month follow-up. There was no statistical difference in either item of SF-36 questionnaire between two groups.ConclusionsCompared with SAC, CDT may facilitate vascular recanalization and shorten symptom resolution for symptomatic SVT.

Incidence patterns and clinical implications of venous thromboembolisms (VTE) in patients (p) with neuroendocrine tumors (NET).

e24155 Background: Venous Thromboembolisms (VTE) is a common complication in cancer patients (p) and one of the lead causes of cancer-related death. Digestive neoplasms have specific characteristics in VTE incidence and treatment. There is a lack of data regarding VTE impact in p with neuroendocrine tumors (NET). Currently few studies have addressed VTE in NET, with an estimated incidence of 7.5%. Nevertheless, there is no evidence from large datasets to address specific implications of thrombosis in NET p. In the present study, we review incidence and treatment of VTE in NET in a large unicentric cohort. Methods: Consecutive p with gastroenteropancreatic (GEP) and thoracic NET treated in our institution were reviewed to study incidence of VTE including deep vein thrombosis (DVT), pulmonary embolisms (PE) and splanchnic venous thrombosis (SVT). Information regarding clinical characteristics and VTE treatment were collected. Results: 212 p were included in the analysis (38% Female; 42% Pancreatic, 35% Small Intestine, 6.5% lung). 50p presented any kind of thrombotic event (23.5%), and 23 were directly related to TNE (10.8%). Considering 23p with TNE-related VTE (82.3% Male; 82.3% Pancreatic), main origins included: SVT 11p (47.8%) and PE 7p (30.4%). Leading cause of SVT was splenic vein thrombosis. 80.9% of VTE cases received anticoagulant therapy, most of them with low-molecular weight heparin (82.6%) and indefinitely duration (58.8%). All cases that did not started anticoagulant therapy were splenic vein thrombosis due to physician decision. Any complication related to anticoagulant therapy was described in 5p (26.3%). No cases of VTE-related death were found. Conclusions: Patients with NET have a moderate risk of VTE events. Splenic thrombosis is the most common location but need of anticoagulant therapy in those cases remains controversial. Specific studies regarding VTE in NET population are needed.

Early systemic anticoagulation reduces hospital readmission in acute necrotizing pancreatitis patients: A retrospective cohort study

BackgroundEarly systemic anticoagulation (SAC) is a common practice in acute necrotizing pancreatitis (ANP), and its impact on in-hospital clinical outcomes had been assessed. However, whether it affects long-term outcomes is unknown. This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients. MethodsDuring January 2013 and December 2018, ANP patients admitted within 7 days from the onset of abdominal pain were screened. The primary outcome was 90-day readmission after discharge. Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission. ResultsA total of 241 ANP patients were enrolled, of whom 143 received early SAC during their hospitalization and 98 did not. Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis (SVT) [risk ratio (RR) = 0.40, 95% CI: 0.26-0.60, P < 0.01] and lower 90-day readmission with an RR of 0.61 (95% CI: 0.41-0.91, P = 0.02) than those who did not. For the quality of life, patients who received early SAC had a significantly higher score in the subscale of vitality (P = 0.03) while the other subscales were all comparable between the two groups. Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57 (95% CI: 0.34-0.96, P = 0.04). Mediation analysis showed that SVT mediated 37.0% of the early SAC-90-day readmission causality. ConclusionsThe application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients, and reduced SVT incidence might be the primary contributor.

Prevalence of portal vein and splanchnic venous thrombosis in dogs with chronic hepatitis.

Alterations in haemostasis have been described in dogs and humans with chronic hepatitis. Portal vein thrombosis is a recognised complication of chronic hepatitis in humans; however, its prevalence in dogs with chronic hepatitis has not been reported. We aimed to estimate the prevalence of, and describe clinical and laboratory data of dogs with chronic hepatitis and portal vein thrombosis and splanchnic venous thrombosis. Retrospective cross-sectional study. Medical records of dogs admitted to a veterinary teaching hospital between 2009 and 2019 were reviewed. Dogs were included if chronic hepatitis was histopathologically confirmed, and if diagnostic imaging or necropsy indicated the presence of thrombosis. Clinical and laboratory data (i.e. haematology, biochemistry, coagulation panels) were recorded. Descriptive statistics were used to characterise dogs with and without thrombosis. Records from 136 dogs with chronic hepatitis were identified. Three of these dogs, 2.2% (95% confidence interval: 0.8 to 6.3%) all females, were diagnosed with portal vein thrombosis. Five dogs in total, (3.7%; 95% confidence interval: 1.6 to 8.3%), including three with portal vein thrombosis, all females, were diagnosed with splanchnic venous thrombosis. Dogs with portal vein and splanchnic venous thrombosis often had hyperbilirubinaemia, increased serum gamma-glutamyl transferase activity, and decreased plasma antithrombin 3 activity. They also had relatively high alternative Child-Pugh scores for dogs (median 6 out of 13). Portal vein and splanchnic venous thrombosis are potentially serious complications that were identified in a relatively low proportion of dogs with chronic hepatitis.

Intravascular Large B-Cell Lymphoma (IVLBCL) Presenting with CNS Involvement in Patient with Chronic Lymphocytic Leukemia

Background: Intravascular lymphoma (IVL) is a rare, often fatal disease characterized by intraluminal proliferation of lymphoid cells within blood vessels. Intravascular Large B-Cell Lymphoma (IVLBCL) is frequently found in different organs, but the skin and central nervous system (CNS) are the most affected ones. Routine radiological examination and additional diagnostic tools, such as high-resolution, three-dimensional (3D) FLAIR sequence, T2-weighted (T2W) and T1-weighted (T1W) contrast-enhanced magnetic resonance imaging (MRI), MRI diffusion and perfusion imaging studies are useful to confirm the diagnosis in cases where it is not easy to perform histopathological examinations [1]. 1.2. Case Report: We present a clinical case of a 63-year-old female patient who presented with progressive cognitive deficit as mild motor aphasia, acalculia, agraphia, dyslexia and mild ideomotor apraxia without any signs of other organ involvement. It was known that the patient had 5-year anamnesis of chronic lymphocytic leukemia, stage II and splanchnic venous thrombosis 2 months ago. Blood biochemical analysis without any significant change, except leukocytosis in full blood count (leukocytes 15,2 x 10*9/L, where neutrophils were in normal range, but lymphocytes were increased). Head magnetic resonance imaging (MRI) showed pathological signal areas on the left parietal lobe with hypointense signal on contrast-enhanced T1-weighted, hyperintense signal on contrast-enhanced T2-weighted and FLAIR-weighted MRI images with restricted diffusion and slightly lower ADC value. Magnetic resonance perfusion imaging studies did not show an increase in cerebral blood flow or in cerebral blood volume. In this case, the patient’s diagnosis was made based on typical radiological features. 1.3. Conclusions: Intravascular large B-cell lymphoma is a rare subtype of extra nodal large B-cell lymphoma with an aggressive clinical course. The diagnosis is challenging, as it presents without any obvious tumour mass or lymphadenopathy. [2] As the clinical presentation is variable without specific characteristics, mostly biopsy or even autopsy confirms the definite diagnosis. But in some cases, the diagnosis can be made by typical radiological findings in the restricted availability of brain biopsy.

HPB P25 Incidence of pancreatitis induced vascular complications in a tertiary care hospital

Abstract Background Pancreatitis (AP) is a common cause of hospital admission, which can lead to vascular complications such as splanchnic venous thrombosis (SpVT), pseudoaneurysm and haemorhage. These complications can happen with both acute and chronic pancreatitis and can be associated with high morbidity and mortality. The aim of this study was to assess incidence of vascular complications in acute pancreatitis patients in a tertiary care hospital. Secondary aims included describing patient demographics, length of hospital stay, critical care admission, mortality, and assess the association between SpVT and pancreatic necrosis and mortality. Methods This study was done as part of year five elective project in University of Aberdeen Medical School. A retrospective study of acute pancreatitis patients who stayed in Aberdeen Royal Infirmary (ARI) or Dr. Gray's Hospital for ≥2 weeks and cases of mortality from acute pancreatitis irrespective of hospital stay between January 2018 to December 2019. Cases were identified from Health intelligence central data as per local governance protocol. Hospital electronic system (TrackCare) was used to review the clinical and radiological details and data was entered in SPSS software version 27 for analysis. Frequencies and percentages were shown for the categorical data and chi square test was used to compare the variables. A p value less than 0.05 was taken as statistically significant. Results Total 293 patients were admitted with acute pancreatitis during the study period. 52 patients met the inclusion criteria for our study. Of the 52 patients, 50 patients had a CT scan. There were 12 patients (24%) with evidence of vascular complications. 22% of patients had SVT and pseudoaneurysm was seen in 2% of cases. There was no case of haemorrhage. The overall mortality from AP during the study period was 6.5%. There was no statistically significant association between SVT and pancreatic necrosis or mortality. Conclusions Splanchnic venous thrombosis was a more frequent complication compared to pseudoaneurysm and haemorrhage in AP. There was no association between SVT and necrosis or mortality.

HPB P44 Incidence of pancreatitis induced splanchnic venous thrombosis in a tertiary care hospital

Abstract Background Splanchnic venous thrombosis (SPVT) is a well-recognized vascular complication of acute pancreatitis (AP). Exact incidence is not clear, however in recent years, the incidence of SPVT is on the rise. This is partially attributed by the availability of computed tomography. Most commonly involved veins are splenic vein (SV), superior mesenteric vein (SMV) and portal vein (PV) in the same order of frequency. Systemic anticoagulation is the presumed treatment for SPVT but evidence of benefit is still not clear. Further complications such as gastrointestinal bleeding, intestinal ischemia, anaemia, thrombocytopenia, infection and oesophageal or gastric varices has been documented which may worsen patient's outcomes. Currently, no data on incidence has been documented in Scotland and there are no national guidelines on the anticoagulation management for SPVT in acute pancreatitis. This study aims to determine the incidence of SPVT complicating AP, the possible aetiological risk factor, the correlation of severity of AP with the development of SPVT, the current practice in management via anticoagulation and outcome of these patients, all in a single health board. Methods A cross-sectional study was conducted, including patients admitted to Aberdeen Royal Infirmary (ARI) and Dr. Gray's Hospital (DGH) with the primary diagnosis of AP from 1st January 2017 to 31st March 2018. Data was obtained from the health intelligence as per NHS Grampian protocol. Data collection was conducted retrospectively by assessing patient's electronic records via TrakCare on NHS Grampian computers, then inputted into REDCap software. Variables instruments heading patient background, admission/diagnosis background, pancreatitis severity, microbiology, organ support, feeding and nutrition, imaging/complications, SPVT, inpatient intervention and follow-up was set up. CT severity index (CTSI) was used to stratify pancreatitis severity. These scores were made based on interpretation of CT scans formal reports. Outcomes parameters were measured by length of hospital stay (LOS) in days and death during admission. Lastly, data was exported from REDCap and statistical analyses were conducted in IBM SPSS Statistics Version 27. Mean, standard deviation and range were calculated for continuous variables while frequencies and percentages for categorical variables. Chi-square test was used for correlation between categorical variables. P value of &amp;lt; 0.05 was set as level of significance. Results Of 219 patients admitted with AP, 202 had either CT scan or/and ultrasound scan conducted, recording incidence of SPVT to be 16/202(7.92%). Patients without scans were excluded as presence of undiagnosed due to its asymptomatic nature. Among SPVT group, 8/16(50%) were gallstone-related, 4/16(25%) alcohol, 1/16(6.25%) post-instrumental(iatrogenic) and 3/16(18.75%) idiopathic. Location of thromboses categorised into SV only in 7(43.8%), SMV only 2(12.5%), PV only 1(6.3%), SV+SMV 4(25%) and SV+ SMV+PV 2(12.5%). 125 patients received CT scan, SPVT group displayed 6/125(4.8%) CTSI ranging 0–5 and 9/125(7.2%) for 6–10, while non-SPVT group 101/125(80.8%) and 9/125(7.2%) respectively, p=0.000. Mortality rate due to SPVT recorded 1/10(10%) and LOS ranged from 0–360 days, mean:14.91, SD:41.43, p=0.000. 4/16(25%) SPVT patients had therapeutic anticoagulation, 3/16(18.8%) not anti-coagulated and 9/16(56.4%) had no data. In relation to thromboses site, 1/7(14.29%) SV only thrombosis received anticoagulation, ½(50%) for SMV only, ¼(25%) for SV+SMV and ½(50%) for SMV+SV+PV. On discharge, 5(62.5%) received anticoagulation, 3 months for 4 patients and 6 months for 1, 2/5(40%) oral and 3(60%) injectable. Conclusions Incidence of pancreatitis induced SPVT was 7.29% during the study period. No aetiological risk factor was determined. Severity of pancreatitis measured by CTSI was directly correlated with increased incidence of SPVT. Besides that, a high rate of idiopathic pancreatitis (37.9%) was found which is not in line with NICE guidance. Hence, further investigations should be offered to establish the aetiology of pancreatitis. In NHS Grampian, we observed mainly supportive management in SV thrombosis while anticoagulation commenced for PV and SMV involvement. Extension of thrombosis also prompted initiation of treatment. For future studies, state of splanchnic circulation after anticoagulation, locations of collaterals, acute and late complications among SPVT can be better analysed.