Mapping the vascular complications of acute pancreatitis: focus on splanchnic vein thrombosis

Acute pancreatitis (AP) is an increasingly prevalent inflammatory condition of the pancreas, often leading to severe complications, including splanchnic venous thrombosis (SVT), an underrecognized but clinically significant event. This study aims to evaluate the prevalence of SVT in AP, its impact on clinical outcomes, and the management strategies employed. A retrospective cohort study was conducted on 402 adult patients hospitalized with AP at a single tertiary-care university hospital from January 2018 to December 2023. Patients were included based on at least two of the three established diagnostic criteria for AP and underwent cross-sectional imaging at a minimum of 72 h after symptom onset. SVT was diagnosed using standardized radiological criteria (complete, partial or mural thrombosis) on contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Patients with pre-existing thromboembolic disease were excluded using a predefined screening protocol (review of past imaging, clinical history, hematology diagnoses, and lab data). SVT was identified in 5.5% of patients. The diagnosis timing was standardized: it was assessed on the first cross-sectional imaging performed after 72 h, and repeated if clinical deterioration occurred. Portal vein thrombosis (PVT) being the most common subtype. Patients with SVT had significantly higher severity scores, longer hospital stays, and a greater incidence of local complications, including walled-off necrosis, ascites, and aneurysms. No significant difference in overall mortality was observed. Although 45% of patients with SVT received anticoagulation therapy, no clear association between anticoagulation and SVT evolution could be demonstrated. SVT is a significant complication of AP and correlates strongly with disease severity. However, anticoagulation did not significantly improve recanalization in this cohort. Prospective studies are needed to clarify optimal management.