Long-term Outcomes of Splanchnic Venous Thrombosis in Acute Pancreatitis

Splanchnic venous thrombosis (SVT) involving veins in the vicinity of the pancreas is a significant complication of acute pancreatitis (AP). The natural history of SVT, especially the rates of recanalization, is poorly understood.

This study aimed to evaluate the natural history of SVT in AP, with a focus on recanalization rates and identifying predictors of nonrecanalization.

This was an observational study in which patients with SVT in the setting of AP were included. Patients were followed for at least 6 months. Recanalization was assessed using Doppler ultrasound or CT imaging, and outcomes were classified as complete recanalization, partial recanalization, or nonrecanalization. Statistical analysis was done to identify predictors of nonrecanalization.

Among 814 patients with AP, 92 (11.3%) developed SVT. Of these, 70 met the inclusion criteria. The mean age was 38.1 years, with 92.8% male predominance. Alcohol was the most common etiology (62.8%). The retropancreatic splenic vein was the most commonly affected vessel. At follow-up, complete recanalization was observed in 54.3% of cases, partial recanalization in 2.9%, while 42.8% showed no evidence of recanalization. Therapeutic anticoagulation was administered to 20% of patients without significantly influencing recanalization rates. A BISAP score ≥2 was a significant predictor of nonrecanalization ( P =0.007).

Most patients with SVT following AP demonstrate spontaneous recanalization. A key predictor for nonrecanalization is the severity of pancreatitis.