Long-term Outcomes of Splanchnic Venous Thrombosis in Acute Pancreatitis

Background: 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. Aim: This study aimed to evaluate the natural history of SVT in AP, with a focus on recanalization rates and identifying predictors of nonrecanalization. Materials and Methods: 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. Results: 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). Conclusion: Most patients with SVT following AP demonstrate spontaneous recanalization. A key predictor for nonrecanalization is the severity of pancreatitis.