Splenic vein thrombosis (SVT) is a condition that is largely precipitated by both the acute and chronic forms of pancreatitis [1] [2]. Pancreatitis is responsible for about 60% of cases of SVT, although the latter does not usually transpire during an acute attack, but rather after repeated insult. Patients with a history of pancreatitis have up to a 20% risk of developing SVT [3]. There are other conditions that contribute to the development of SVT to a lesser extent, and these include pancreatic pseudocysts, malignancies, peptic ulcer disease, liver cirrhosis, Mallory-Weiss tears and pancreatic surgery [4] [5]. Pancreatitis can precipitate SVT because of the close association of the tail of the pancreas with the splenic vein. Any inflammation that occurs in the pancreas inflicts damage on the splenic vein wall, leaving it susceptible to thrombus formation [1]. The splenic wall may also be compressed and thus partially occluded by adjacent enlarged lymph nodes.

SVT leads to sinistral portal hypertension, which in turn leads to gastric and esophageal varices. Many individuals with SVT present with gastrointestinal bleeding from varices, which can be life threatening. Nevertheless, most patients with SVT are asymptomatic. SVT should be considered in patients who present with splenomegaly, but no signs of hepatic, hematologic or portal pathology.

The pathophysiology of SVT, sometimes referred to as pancreatitis-induced SVT when it is secondary to pancreatitis, as well as subsequent GI bleeding, is not understood clearly.

• Splenomegaly

  Seven of 9 patients (78 %) with massive splenomegaly (>20 cm) developed PSVT compared with 4 of 13 patients (31 %) with moderate splenomegaly (15-20 cm) and 6 of 45 patients (13 %) without (p CONCLUSION: In patients scheduled for LS, screening for prothrombotic [ncbi.nlm.nih.gov]

  SVT should be considered in patients who present with splenomegaly, but no signs of hepatic, hematologic or portal pathology. [symptoma.com]

• Massive Splenomegaly

  Routine ultrasound examination in the fourth month of the pregnancy revealed massive splenomegaly of unknown origin. Doppler ultrasonography subsequently revealed splenic venous thrombosis with absence of blood flow. [ncbi.nlm.nih.gov]

  Other causes Increased hepatic blood flow: Increased splenic blood flow - eg, massive splenomegaly. Hepatoportal arteriovenous fistula. Idiopathic (a diagnosis of exclusion). Left-sided (sinistral) portal hypertension Rare. [patient.info]

• Abdominal Pain

  Splenic vein thrombosis is an uncommon cause of abdominal pain, but one that should be included in the treating physician's differential diagnoses when abdominal pain is ongoing despite medical therapy. [ncbi.nlm.nih.gov]

  Abstract Abstract 4775 Abdominal pain is a common complaint among all ages of patients. [bloodjournal.org]

• Epigastric Pain

  We report a case of suspected gastrointestinal bleeding in a patient with a childhood history of pancreatitis, who also experienced severe epigastric pain while in hospital. [ncbi.nlm.nih.gov]

  Case 4, a 45-year-old male with acute pancreatitis, presented with epigastric pain. CT showed splenic vein thrombosis, and the patient was treated with Coumadin. [bloodjournal.org]

  He was presented to the hospital due to his upper respiratory symptoms complaints and noted mild-to-moderate epigastric pain. Results of chest radiography and electrocardiography showed... [connection.ebscohost.com]

• Left Upper Quadrant Pain

  Case 1, a 45-year-old male with sickle cell trait (HbS of 38.7%), presented with left upper quadrant pain after 5-hour flight and alcohol binge prior to flight. CT showed splenic infarct and splenic vein thrombosis. [bloodjournal.org]

• Pancreatic Pain

  Surgical candidates are those who present with Symptomatic SVO and those with severe pancreatic pain who needs surgery for pancreatic procedures. [pancreas.imedpub.com]

• Lacrimation

  Add a translation Last Update: 2017-04-26 Usage Frequency: 4 English Lacrimation increased, Conjunctivitis, Eye irritation Last Update: 2011-10-23 Usage Frequency: 1 Warning: This alignment may be wrong. Please delete it you feel so. [mymemory.translated.net]

• Oliguria

  The authors present the case of a 17 year old girl admitted to hospital for poor general state, mild scleral jaundice, deficient nutritional state, oliguria and massive ascites. [ncbi.nlm.nih.gov]

There are several diagnostic modalities for splenic vein thrombosis available to clinicians. These include:

Invasive techniques

• Celiac angiography (late-phase): This is the preferred technique for detecting SVT, especially in the presence of GI bleeding.
• Splenoportography.
• Esophagogastroduodenoscopy (EGD): An endoscopic technique to diagnose varices. Its sensitivity varies because it is user dependent [6] [7].

Non-invasive techniques: These are increasingly instrumental in the diagnosis of SVT and pancreatitis, as their efficacy has improved.

• Ultrasound
• Computerized tomography: This is routinely carried out with contrast. It can also be useful as a screening tool [6] [8].
• Magnetic resonance imaging (MRI)

A dated diagnostic technique was post mortem analysis.

Patients should be evaluated for GI bleeding, specifically esophageal and gastric varices. The isolated presence of gastric varices, in the absence of esophageal counterparts, is highly suggestive of SVT. About half of individuals with splenic vein thrombosis present with splenomegaly. This is helpful in diagnosis, but its absence does not rule out the possibility of SVT [2]. Given the ambivalence of signs and symptoms in SVT, its diagnosis relies heavily on medical imaging.

• Gastric Varices

  This risk of variceal bleeding was 5% for patients with CT-identified varices and 18% for EGD-identified varices. Overall, only 2 patients (4%) had gastric variceal bleeding and required splenectomy. [ncbi.nlm.nih.gov]

  Management is primarily aimed at decreasing variceal bleeding. INCPH can have esophageal and gastric varices. Gastric varices arising without the involvement of esophageal varices (EV) are termed isolated gastric varices (IGV). [cureus.com]

  Bleeding from gastric varices (GVs) is generally more severe than from esophageal varices [ 2 ], although it occurs less frequently [ 3 – 5 ]. [jmedicalcasereports.com]

• Nephrolithiasis

  Case Presentation A 60-year-old-male with past medical history of hypertension, hyperlipidemia, and nephrolithiasis presented with acute onset of hematemesis. He denied history of non-steroidal, anti-inflammatory drugs or alcohol use. [cureus.com]

• Gastric Lesion

  Although this gastric mucosal lesion has been occasionally described in extrahepatic portal hypertension, its clinical significance and histological features are not well established. [ncbi.nlm.nih.gov]

BACKGROUND: Optimal modalities for diagnosis, treatment, and surveillance of portal or splenic vein thrombosis have not yet been defined. [ncbi.nlm.nih.gov]

To improve our approach to treatment we reviewed 30 cases of SVT associated with CP treated in our centre from 1985 to 1995. 14 patients were treated conservatively. [unboundmedicine.com]

Prognosis The overall prognosis is good, with 75% of patients alive after 10 years and an overall mortality rate of less than 10%. [emedicine.medscape.com]

[…] paraoesophageal collaterals omental collaterals retroperitoneal collaterals mesenteric collaterals splenorenal collaterals gastrorenal collaterals splenomegaly ascites cause of portal hypertension often identified, most commonly liver cirrhosis Treatment and prognosis [radiopaedia.org]

Prognosis This depends on the prognosis of the underlying disease, and on the outcome of any complications such as variceal bleeding. [patient.info]

Pancreatic diseases are among the most common etiologies of splenic vein obstruction. Renal disorders are rarely reported as a cause of splenic vein thrombosis. [ncbi.nlm.nih.gov]

Etiology Children In children and neonates, the most common etiology is intra-abdominal infection, accounting for 50% of all cases in this age group. [emedicine.medscape.com]

The epidemiology and pathogenesis of PVT, as well as the approach to patients with chronic PVT are discussed elsewhere. [uptodate.com]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Epidemiology United States statistics Portal vein obstruction is a relatively rare condition with an overall incidence of 0.05-0.5% in autopsy studies. [emedicine.medscape.com]

There are multiple other terms used globally, and although there are reported differences in etiology, epidemiology, and hepatic pressures, these various presentations likely reflect the vast spectrum of the condition itself and not the distinct diseases [cureus.com]

We propose possible pathophysiologic mechanisms and recommend that splenic vein thrombosis be considered in the differential diagnosis of unexplained left-sided pleural effusions. [ncbi.nlm.nih.gov]

The pathophysiology of SVT, sometimes referred to as pancreatitis-induced SVT when it is secondary to pancreatitis, as well as subsequent GI bleeding, is not understood clearly. [symptoma.com]

Home | CCC | Portal vein thrombosis by, last update April 25, 2019 OVERVIEW thrombus formation in the portal vein +/- tributaries (SMV, IMV and splenic vein) PATHOPHYSIOLOGY can be acute or chronic clot can be within liver or external clot can be occluding [lifeinthefastlane.com]

García-Pagán JC, Gracia-Sancho J, Bosch J: Functional aspects on the pathophysiology of portal hypertension in cirrhosis. [cureus.com]

The three effusions due to splenic hematomas reported previously cleared only after splenectomy, suggesting splenectomy may be necessary to prevent reaccumulation. [ncbi.nlm.nih.gov]

The results suggest that early surgical intervention is beneficial in preventing progression of SVT to the portomesenteric vein. [unboundmedicine.com]

Repermeation prevents ischemic intestinal injury and extrahepatic portal hypertension. However, the standard protocol for anticoagulation in portal vein thrombosis has not yet been determined. [ekjm.org]

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