Junare Parmeshwar Ramesh, Udgirkar Suhas, Nair Sujit, Debnath Prasanta, Jain Shubham, Modi Ammar, Rathi Pravin, Rane Siddhesh, Contractor Qais
Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital,Mumbai, India.
Department of Radio-Diagnosis, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital,Mumbai, India.
Gastroenterology Res. 2020 Feb;13(1):25-31. doi: 10.14740/gr1223. Epub 2020 Feb 1.
Splanchnic venous system thrombosis is a well recognized local vascular complication of acute pancreatitis (AP). It may involve thrombosis of splenic vein (SplV), portal vein (PV) and superior mesenteric vein (SMV), either separately or in combinations, and often detected incidentally, indeed some cases present with upper gastrointestinal bleed, bowel ischemia and hepatic decompensation. Incidence is variable depending on study subjects and diagnostic modalities. Pathogenesis is multifactorial centered on local and systemic inflammation. Management involves treatment of underlying AP and its complications. Universal use of anticoagulation may lead to increased risk of bleeding due to frequent need of interventions (radiologic/endoscopic/surgical). Literature on anticoagulation in setting of AP is sparse and at present there is no consensus guideline on it. Current article details our experience on splanchnic venous thrombosis (SVT) in AP in a well defined cohort of patients at a tertiary care center.
Hospitalized patients with AP from January 2018 to December 2018 were included in the study. Detailed information on demographic, clinical, laboratory, radiologic features, and indication of anticoagulation use were collected prospectively during the index admission. Outcome variables were analyzed at the end of 6 months.
Twenty four out of 105 (22.85%) patients with AP develop SVT. Etiology of AP was alcohol use in 21/24 (87.5%) subjects. Most common vessel involved was isolated SplV in 11/24 (45.8%) patients followed by SplV along with PV and SMV 9/24 (37.50%, P < 0.001). Bowel ischemia 4/12 (33.3%), hepatic decompensation 3/12 (25%), triple vessel involvement 4/12 (33.3%) and pulmonary embolism 1/12 (8.3%) were reasons for anticoagulation. There was no statistical difference with respect to development of varices, collateral formation, recanalization, bleeding and mortality with use of anticoagulation (P > 0.05 with respect to all above variables).
SVT is commonly seen in alcohol-induced AP. Anticoagulation does not affect outcomes of SVT. Subset of patients may benefit with anticoagulation.
内脏静脉系统血栓形成是急性胰腺炎（AP）一种公认的局部血管并发症。它可能单独或合并累及脾静脉（SplV）、门静脉（PV）和肠系膜上静脉（SMV）血栓形成，且常为偶然发现，实际上一些病例表现为上消化道出血、肠缺血和肝功能失代偿。发病率因研究对象和诊断方式而异。发病机制是多因素的，以局部和全身炎症为中心。治疗包括治疗潜在的AP及其并发症。由于频繁需要进行干预（放射学/内镜/手术），普遍使用抗凝治疗可能会导致出血风险增加。关于AP背景下抗凝治疗的文献稀少，目前对此尚无共识性指南。本文详述了我们在一家三级医疗中心对一组明确患者中AP合并内脏静脉血栓形成（SVT）的经验。
纳入2018年1月至2018年12月住院的AP患者。在首次住院期间前瞻性收集有关人口统计学、临床、实验室、放射学特征以及抗凝治疗使用指征的详细信息。在6个月末分析结局变量。
105例AP患者中有24例（22.85%）发生SVT。24例患者中21例（87.5%）AP的病因是饮酒。最常受累血管是11例（45.8%）患者的孤立性脾静脉，其次是9例（37.50%，P<0.001）患者的脾静脉合并门静脉和肠系膜上静脉。抗凝治疗的原因包括肠缺血4例（33.3%）、肝功能失代偿3例（25%）、三支血管受累4例（33.3%）和肺栓塞1例（8.3%）。使用抗凝治疗在静脉曲张形成、侧支循环形成、再通、出血和死亡率方面无统计学差异（上述所有变量P>0.05）。
SVT常见于酒精性AP。抗凝治疗不影响SVT的结局。部分患者可能从抗凝治疗中获益。
