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Wei W, Ma Y, Zeng J, Song Y, Han Y, Qian W, Yang X, Wu Z, Ma Z, Wang Z, Duan W. A Nomogram for Predicting the Transition From Recurrent Acute Pancreatitis to Chronic Pancreatitis. Pancreas 2025; 54:e201-e209. [PMID: 39999313 PMCID: PMC11882177 DOI: 10.1097/mpa.0000000000002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/11/2024] [Indexed: 02/27/2025]
Abstract
OBJECTIVES Acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis are recognized as a continuum of pancreatic diseases. Recurrence increases the risk of progression to chronic pancreatitis. The aim of this study was to search for clinical features that may promote the progression of chronic pancreatitis in patients with recurrent acute pancreatitis. MATERIALS AND METHODS We retrospectively reviewed patients with recurrent acute pancreatitis from Medical Information Mart for Intensive Care-IV database. They were divided into a training cohort and a validation cohort. A nomogram was constructed based on clinical features during the second hospitalization. The discrimination and calibration of the nomogram were evaluated using the concordance index, area under the time-dependent receiver operating characteristic curve, and calibration plots. RESULTS A total of 432 recurrent acute pancreatitis patients were evaluated, of which 93 (21.53%) were diagnosed with chronic pancreatitis later. Age, biliary pancreatitis, admission interval, alcohol dependence, lipase, and platelet were selected. The concordance index was 0.717 (95% confidence interval: 0.691-0.743) for the training cohort and 0.718 (95% confidence interval: 0.662-0.774) for the validation cohort. The area under the time-dependent receiver operating characteristic curve was >0.7 over 1000 days. CONCLUSIONS A nomogram was developed and validated to evaluate the transition from recurrent acute pancreatitis to chronic pancreatitis.
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Borbély RZ, Teutsch B, Hegyi P. Incidence and Management of Splanchnic Vein Thrombosis in Pancreatic Diseases. United European Gastroenterol J 2025; 13:86-96. [PMID: 39743752 PMCID: PMC11866318 DOI: 10.1002/ueg2.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 11/11/2024] [Accepted: 11/12/2024] [Indexed: 01/04/2025] Open
Abstract
Splanchnic vein thrombosis (SVT) in pancreatic disease has a 20%-30% incidence rate, leading to increased mortality and complication rates. Therefore, the aim of this review is to summarize recent evidence about the incidence, risk factors, and management of pancreatic cancer, pancreatic cystic neoplasm-, and pancreatitis-related SVT. Doppler ultrasound should be the first imaging choice, followed by contrast-enhanced computed tomography or magnetic resonance imaging. Data regarding SVT treatment in acute pancreatitis and pancreatic cancer are scarce; however, for venous thromboembolism treatment, direct oral anticoagulants and low molecular weight heparin have been effective. Further trials must investigate the length of anticoagulant treatment and the need for interventional radiological procedures.
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Affiliation(s)
- Ruben Zsolt Borbély
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Medical ImagingBajcsy‐Zsilinszky Hospital and ClinicBudapestHungary
| | - Brigitta Teutsch
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Department of RadiologyMedical Imaging CentreSemmelweis UniversityBudapestHungary
| | - Péter Hegyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Institute of Pancreatic DiseasesSemmelweis UniversityBudapestHungary
- Translational Pancreatology Research GroupInterdisciplinary Center of Excellence for Research Development and InnovationUniversity of SzegedSzegedHungary
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Vergadoro M, Spiezia L, Zanetto A, Zola E, Simioni P. Unusual-site thrombosis in patients with hazardous alcohol use: a narrative review. Alcohol Alcohol 2025; 60:agaf007. [PMID: 40052444 DOI: 10.1093/alcalc/agaf007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 02/09/2025] [Accepted: 02/17/2025] [Indexed: 05/13/2025] Open
Abstract
AIMS AND METHODS Hazardous alcohol use poses an increasing public health issue worldwide and it manifests as excessive consumption (acute or chronic), which may lead to addiction. The risk of alcohol-related pathologies correlates with the patterns of intake and increases with the amount of alcohol consumed. While the effects of alcohol consumption on ischemic stroke and ischemic heart disease are well documented, the impact on venous thromboembolism is less clear. Conflicting studies have reported that alcohol may be a risk factor for, or have a protective role against venous thromboembolism. Our narrative review aimed to assess the risk of unusual-site venous thrombosis in individuals with hazardous alcohol use, as it may stem from alcohol-related organ damage (e.g. liver cirrhosis, pancreatitis) as well as provide some suggestions for physicians. RESULTS There appears to be a correlation between hazardous alcohol use and unusual-site thrombosis, though the underlying mechanisms are largely still unknown. CONCLUSION In subjects with hazardous alcohol use complicated by alcohol-related organ damage, physicians should be vigilant for potential thrombotic symptoms, and be prepared to diagnose and promptly initiate appropriate anticoagulation therapy.
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Affiliation(s)
- Margherita Vergadoro
- First Chair of Internal Medicine, Alcohol Related Diseases Unit, Department of Medicine (DIMED), University Hospital of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
- School of Community Medicine and Primary Health Care, Department of Medicine (DIMED), School of Medicine, University of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Luca Spiezia
- School of Community Medicine and Primary Health Care, Department of Medicine (DIMED), School of Medicine, University of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
- First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine (DIMED), University Hospital of Padua Medical School, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Alberto Zanetto
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Erika Zola
- First Chair of Internal Medicine, Alcohol Related Diseases Unit, Department of Medicine (DIMED), University Hospital of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
- First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine (DIMED), University Hospital of Padua Medical School, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Paolo Simioni
- First Chair of Internal Medicine, Alcohol Related Diseases Unit, Department of Medicine (DIMED), University Hospital of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
- School of Community Medicine and Primary Health Care, Department of Medicine (DIMED), School of Medicine, University of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
- First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine (DIMED), University Hospital of Padua Medical School, Via Giustiniani, 2 - 35128 Padova, Italy
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Spaska A. Correlation of the anatomical variations of pancreatic blood vessels and occurrence of diseases of pancreas. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2025; 53:100-107. [PMID: 40063918 DOI: 10.36740/merkur202501114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
OBJECTIVE Aim: The research aims to confirm or reject the hypothesis on the possible relationship between the influence of changes in pancreatic vascular variations on the mechanisms of occurrence of pancreatic diseases based on the collected scientific literature.. PATIENTS AND METHODS Materials and Methods: The bibliosemantic, bibliographic, statistical research methods were used in the research. Scientometric databases Web of Science, Scopus, PubMed, and archives of scientific papers such as Google Scholar and Research Gate for the last 6 years (2018-2023) were used to form a study basis. CONCLUSION Conclusions: Based on the analyzed sources, blood supply variants to the pancreas do not influence the development of pathological processes. However, vein and artery features impact treatment choices and surgical outcomes. Main and additional pancreatic ducts, and the common bile duct, may be linked to diseases. Atypical pancreatic artery branching affects surgical tactics and increases bleeding risk.
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Safar A, AlFawaz A. Superior pancreaticoduodenal artery pseudoaneurysm with subsequent hemosuccus pancreaticus: an unusual complication of chronic pancreatitis. Arch Clin Cases 2024; 11:114-119. [PMID: 39712553 PMCID: PMC11661550 DOI: 10.22551/2024.45.1104.10301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2024] Open
Abstract
The development of an arterial pseudoaneurysm is an unusual complication of chronic pancreatitis. The most commonly involved artery is the splenic artery. This is a case report describing a case of a superior pancreaticoduodenal artery pseudoaneurysm in a patient with chronic pancreatitis who developed hemosuccus pancreaticus. A 46-year-old man with history of binge ethanol intake presented to the emergency department with abdominal pain. A computed tomography (CT) scan showed features of chronic pancreatitis along with a 2 x 1.8 cm enhancing mass at the level of the pancreatic head, consistent with an arterial pseudoaneurysm in close proximity to the pancreatic duct as confirmed on endoscopic ultrasound. He underwent an endoscopic retrograde cholangiopancreatography in the context of a rise in his liver enzymes with the presence of gallbladder sludge. This was complicated by hemosuccus pancreaticus, which was successfully managed with percutaneous angioembolization. Despite its unusual incidence, pseudoaneurysm remains an important complication of chronic pancreatitis with a high mortality rate in case of acute hemorrhage. Diagnostic modalities include abdominal CT and Color Doppler ultrasound. Endovascular techniques are considered to be the first line of therapy in most cases. Early recognition and management of pancreatic pseudoaneurysms is important to avoid life-threatening hemorrhage.
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Affiliation(s)
- Ali Safar
- Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Abdullah AlFawaz
- Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Walia D, Saraya A, Gunjan D. Vascular complications of chronic pancreatitis and its management. World J Gastrointest Surg 2023; 15:1574-1590. [PMID: 37701688 PMCID: PMC10494584 DOI: 10.4240/wjgs.v15.i8.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 08/25/2023] Open
Abstract
Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.
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Affiliation(s)
- Dinesh Walia
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anoop Saraya
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Gunjan
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
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Füssel LM, Müller-Wille R, Dinkhauser P, Schauer W, Hofer H. Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: A case report and literature review. World J Gastroenterol 2023; 29:3922-3931. [PMID: 37426315 PMCID: PMC10324528 DOI: 10.3748/wjg.v29.i24.3922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/27/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option.
CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.
CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.
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Affiliation(s)
- Lisa-Michaela Füssel
- Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Rene Müller-Wille
- Department of Radiology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Patrick Dinkhauser
- Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Walter Schauer
- Department of Abdominal Surgery, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Harald Hofer
- Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
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Garg R, Mohammed A, Singh A, Siddiki H, Bhatt A, Sanaka MR, Jang S, Simons-Linares CR, Stevens T, Vargo J, Chahal P. Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study. Dig Dis Sci 2023; 68:2674-2682. [PMID: 37097368 DOI: 10.1007/s10620-023-07945-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients. METHODS The National Inpatient Sample database was utilized to identify the adult patients (≥ 18 years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified. RESULTS Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients. CONCLUSION PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Abdul Mohammed
- Department of Gastroenterology and Hepatology, Advent Health, Orlando, FL, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Siddiki
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Stevens
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Jia F, Xia G, Zhu Q, Yu S, Hu N, Zhang H. Hepatic artery pseudoaneurysm caused by chronic pancreatitis: Case report and literature review. Medicine (Baltimore) 2023; 102:e32834. [PMID: 36749241 PMCID: PMC9901987 DOI: 10.1097/md.0000000000032834] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
RATIONALE Visceral artery pseudoaneurysm is a rare complication of chronic pancreatitis (CP), all pancreatic or peripancreatic arteries have been reported to be involved, while hepatic artery is less common. PATIENT CONCERNS This case report illustrated a 42-year-old man with CP who developed right hepatic artery pseudoaneurysm (HAP), and finally he was treated with intravascular embolization. DIAGNOSES The patient suffered from HAP due to acute attack of CP. INTERVENTIONS The pseudoaneurysm located in a fine branch of right hepatic artery was embolized. OUTCOMES The HAP of the patient was cured. He had no recurrent bloody stool or abdominal pain. The symptoms gradually relieved. CONCLUSION Herein, we report a patient with CP who developed right HAP causing infected hematoma, gastrointestinal bleeding, and obstructive jaundice, and a literature review is also presented. HAP caused by CP is a rare disease in the clinic, but rupture of pseudoaneurysm is fatal. Careful evaluation, early detection, and prompt treatment should be performed when the patient is admitted and followed up.
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Affiliation(s)
- Fengjuan Jia
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Guodong Xia
- Health Management Centre, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qingliang Zhu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Shuangyu Yu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Nan Hu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Hailong Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- * Correspondence: Hailong Zhang, The Affiliated Hospital of Southwest Medical University, No. 25, Taiping Street, Luzhou, Sichuan Province 646000, China (e-mail: )
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A selective anticoagulation policy for splanchnic vein thrombosis in acute pancreatitis is associated with favourable outcomes: experience from a UK tertiary referral centre. HPB (Oxford) 2022; 24:1937-1943. [PMID: 35786365 DOI: 10.1016/j.hpb.2022.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION There is a paucity of data on the incidence, risk factors, and treatment of splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). METHODS All AP admissions between 2018 and 2021 across North East of England were included. Anticoagulation was considered in the presence of superior mesenteric vein/portal vein (SMV/PV) thrombus or progressive splenic vein thrombus (SpVT). The impact of such a selective anticoagulation policy, on vein recanalisation rates and bleeding complications were explored. RESULTS 401 patients (median age 58) were admitted with AP. 109 patients (27.2%) developed SVT. The splenic vein in isolation was the most common site (n = 46) followed by SMV/PV (n = 36) and combined SMV/PV and SpVT (n = 27). On multivariate logistic regression alcohol aetiology (OR 2.64, 95% CI [1.43-5.01]) and >50% necrosis of the pancreas (OR 14.6, 95% CI [1.43-383.9]) increased the risk of developing SVT. The rate of recanalization with anticoagulation was higher for PVT (66.7%; 42/63) than in SpVT (2/11; p = 0.003). 5/74 of anticoagulated patients developed bleeding complications while 0/35 patients not anticoagulated had bleeding complications (p = 0.4). CONCLUSION The risk of SVT increases with AP severity and with extent of pancreatic necrosis. A selective anticoagulation policy for PVT and progressive SpVT in AP is associated with favourable outcomes with no increased risk of bleeding complications.
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Dutta S, Pal B, Ram D, Shyamprasad SK, Ramakrishnaiah VPN. Successful use of a mesocaval shunt to treat refractory ascites in a chronic pancreatitis induced portal vein thrombosis. Ann Hepatobiliary Pancreat Surg 2022; 26:204-209. [PMID: 35193995 PMCID: PMC9136419 DOI: 10.14701/ahbps.21-146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
The state of intense peripancreatic inflammation in chronic pancreatitis can give rise to various vascular complications such as venous thrombosis and arterial pseudoaneurysms. Due to its intimate location with the pancreas, spleno-mesenteric-portal axis suffers the greatest blunt of thrombotic complications. Treatment modalities for such cases of chronic portal vein thrombosis have always been controversial and challenging. Medical management with anticoagulants is both risky and unsatisfactory due to presence of varices, hypersplenism, and persistence of the inflammatory pathology. Although endovascular techniques have been tried in various case reports, there are definite anatomical challenges in cases of long segment porto-mesenteric thrombosis with massive ascites. Surgical shunts have been historically described for cirrhotic and non-cirrhotic portal hypertensive patients. However, its use in patients with refractory ascites due to chronic pancreatitis induced portal vein thrombosis has not been reported in the medical literature. Here, we present a case of an extensive portal vein thrombosis with massive refractory ascites in a patient with alcohol-induced chronic pancreatitis successfully treated with a surgical mesocaval shunt using an interposition small diameter graft.
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Affiliation(s)
- Souradeep Dutta
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Bishal Pal
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Duvuru Ram
- Department of Cardiovascular and Thoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sreevathsa Kadaba Shyamprasad
- Department of Cardiovascular and Thoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Vujasinovic M, Dugic A, Nouri A, Brismar TB, Baldaque-Silva F, Asplund E, Rutkowski W, Ghorbani P, Sparrelid E, Hagström H, Löhr JM. Vascular Complications in Patients with Chronic Pancreatitis. J Clin Med 2021; 10:3720. [PMID: 34442016 PMCID: PMC8396906 DOI: 10.3390/jcm10163720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Chronic pancreatitis (CP) is a long-standing progressive inflammation of the pancreas, which can lead to a variety of vascular complications, such as splanchnic venous thrombosis (VT) and arterial pseudoaneurysm (PA). There is a lack of studies on vascular complications in Scandinavian countries. METHODS We performed a retrospective analysis of medical records of patients with CP identified from the Karolinska University Hospital database between 2003 and 2018. A total of 394 patients with definite CP were included in the study. RESULTS There were 33 patients with vascular complications, with a median age of 62 (IQR 55-72) years. The cumulative incidence of vascular events was 3.2% at 5 years. Thirty patients had isolated VT, whereas three patients had PA (7.6% and 0.8%, respectively). Isolated splenic vein thrombosis was most common (53.3%), followed by a combination with other splanchnic veins. PA was found in the splenic artery in two patients and in the left gastric artery in one patient. Varices were present in three (10%) patients; variceal bleeding was not recorded. All patients had asymptomatic splanchnic VT, most with chronic VT with developed collaterals (83.3% had abdominal collateral vessels). Nearly two-thirds of patients with VT (63.3%) received no treatment, whereas 11 (36.6%) were treated with anticoagulants. Pseudocysts and alcoholic etiology of CP are risk factors for vascular complications. CONCLUSIONS The cumulative incidence of vascular complications was 3.2% at 5 years. Splanchnic VT is more common than PA. Patients were asymptomatic with no variceal bleeding, explained by well-developed collateral vessels and strong study inclusion criteria.
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Affiliation(s)
- Miroslav Vujasinovic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden; (F.B.-S.); (W.R.); (P.G.); (E.S.); (H.H.); (J.-M.L.)
- Department of Medicine, Huddinge, Karolinska Institutet,141 86 Stockholm, Sweden; (A.D.); (A.N.); (E.A.)
| | - Ana Dugic
- Department of Medicine, Huddinge, Karolinska Institutet,141 86 Stockholm, Sweden; (A.D.); (A.N.); (E.A.)
| | - Amar Nouri
- Department of Medicine, Huddinge, Karolinska Institutet,141 86 Stockholm, Sweden; (A.D.); (A.N.); (E.A.)
| | - Torkel B Brismar
- Department of Radiology, Karolinska University Hospital, 141 86 Stockholm, Sweden;
| | - Francisco Baldaque-Silva
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden; (F.B.-S.); (W.R.); (P.G.); (E.S.); (H.H.); (J.-M.L.)
- Department of Medicine, Huddinge, Karolinska Institutet,141 86 Stockholm, Sweden; (A.D.); (A.N.); (E.A.)
| | - Ebba Asplund
- Department of Medicine, Huddinge, Karolinska Institutet,141 86 Stockholm, Sweden; (A.D.); (A.N.); (E.A.)
| | - Wiktor Rutkowski
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden; (F.B.-S.); (W.R.); (P.G.); (E.S.); (H.H.); (J.-M.L.)
- Department of Medicine, Huddinge, Karolinska Institutet,141 86 Stockholm, Sweden; (A.D.); (A.N.); (E.A.)
| | - Poya Ghorbani
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden; (F.B.-S.); (W.R.); (P.G.); (E.S.); (H.H.); (J.-M.L.)
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Ernesto Sparrelid
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden; (F.B.-S.); (W.R.); (P.G.); (E.S.); (H.H.); (J.-M.L.)
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Hannes Hagström
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden; (F.B.-S.); (W.R.); (P.G.); (E.S.); (H.H.); (J.-M.L.)
- Department of Medicine, Huddinge, Karolinska Institutet,141 86 Stockholm, Sweden; (A.D.); (A.N.); (E.A.)
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - J.-Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden; (F.B.-S.); (W.R.); (P.G.); (E.S.); (H.H.); (J.-M.L.)
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, 141 86 Stockholm, Sweden
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Vascular complications of chronic pancreatitis: A tertiary center experience. Pancreatology 2020; 20:1796. [PMID: 33158774 DOI: 10.1016/j.pan.2020.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/11/2022]
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