Impact of Splanchnic Vein Thrombosis on Outcomes of Interventions in Patients With Pancreatic Fluid Collections Following Acute Pancreatitis–A Prospective Observational Study

BACKGROUND: Splanchnic vein thrombosis (SVT) is common in acute pancreatitis (AP) and often leads to intra-abdominal collaterals, increasing the risk of bleeding during interventions. However, data on its impact on intervention outcomes are limited. We prospectively assessed the effect of SVT on outcomes of interventions for symptomatic pancreatic fluid collections (PFCs). METHODS: Fifty patients (mean age: 40.9 y; 62% male) with symptomatic PFCs were prospectively evaluated. Contrast-enhanced CT was used to assess PFCs, detect SVT, and identify intra-abdominal venous collaterals (IAVCs). Patients underwent percutaneous drainage (PCD), endoscopic transmural drainage (TMD), or surgery, based on the treating clinician's discretion. Follow-up lasted 6 months, and outcomes were compared between patients with and without SVT. RESULTS: SVT was present in 18 (36%) patients; IAVCs were seen in 8 (16%). Splenic vein thrombosis occurred in 17 (34%), portal vein in 7 (14%), and superior mesenteric vein in 8 (16%). Thirty-nine (78%) underwent PCD, 11 (22%) TMD, and 13 (26%) required surgery. Eleven (22%) patients died, with similar mortality between the SVT and non-SVT groups. Hospital and ICU stay lengths were comparable. Bleeding rates did not differ significantly [SVT vs. no SVT: 2 (11.1%) vs. 2 (6.25%); P =0.612]. CONCLUSIONS: SVT was not associated with increased complications, bleeding risk, or mortality following interventions for symptomatic PFCs in AP.