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Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis

A L Warshaw, G L Jin, L W Ottinger

    Archives of Surgery (Chicago, Ill. : 1960)
    |April 1, 1987
    PubMed

    Insights

    Superior mesenteric and portal vein obstruction is a newly recognized complication of chronic pancreatitis. This condition can cause variceal bleeding and mimic pancreatic cancer on imaging.

    Area of Science:

    • Gastroenterology
    • Vascular Surgery
    • Radiology

    Background:

    • Splenic vein obstruction is a known complication of chronic pancreatitis.
    • Occlusion of the superior mesenteric and/or portal veins (SMV-PV) in chronic pancreatitis is not well-appreciated.
    • This study investigates SMV-PV obstruction in patients with chronic pancreatitis without malignancy.

    Purpose of the Study:

    • To describe the occurrence and clinical significance of SMV-PV obstruction in chronic pancreatitis.
    • To highlight the diagnostic challenges and potential complications associated with this condition.

    Main Methods:

    • Retrospective review of 14 patients with chronic pancreatitis and SMV-PV obstruction.
    • Analysis of clinical presentation, angiographic findings, and surgical outcomes.
    • Comparison with known features of splenic vein obstruction.

    Main Results:

    • SMV-PV obstruction was identified in 14 patients with chronic pancreatitis.
    • Portal hypertension was suspected due to variceal bleeding or incidental varices.
    • Angiographic findings mimicked pancreatic cancer; splenic vein was also occluded in 8/13 patients.
    • Liver function remained normal in all cases.

    Conclusions:

    • SMV-PV obstruction is a significant, under-recognized complication of chronic pancreatitis.
    • It presents with variceal bleeding, necessitating specific management strategies.
    • It can complicate pancreatic surgery and be confused with pancreatic cancer.

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