Venous Complications of Pancreatitis: A Review

  • Yashant Aswani Department of Radiology, Seth GS Medical College and KEM Hospital. Mumbai, Maharashtra, India
  • Priya Hira Department of Radiology, Seth GS Medical College and KEM Hospital. Mumbai, Maharashtra, India

Abstract

Pancreatitis is notorious to cause vascular complications. While arterial complications include pseudoaneurysm formation with a propensity to bleed, venous complications can be quite myriad. Venous involvement in pancreatitis often presents with thrombosis. From time to time case reports and series of unusual venous complications associated with pancreatitis have, however, been described. In this article, we review multitudinous venous complications in the setting of pancreatitis and propose a system to classify pancreatitis associated venous complications.

Image: Dilated venous channels in the wall of gallbladder at sonogram.

Downloads

Download data is not yet available.

References

Mallick IH, Winslet MC. Vascular complications of pancreatitis. JOP 2004; 5 (5): 328-37. [PMID: 15365199]

Park WS, Kim HI, Jeon BJ, Kim SH, Lee SO. Should anticoagulants be administered for portal vein thrombosis associated with acute pancreatitis? World J Gastroenterol 2012; 18(42): 6168-71. [PMID: 23155349]

Sakorafas GH, Tsiotou AG. Splenic-vein thrombosis complicating chronic pancreatitis. Scand J Gastroenterol 1999; 34: 1171-7. [PMID: 10636062]

Izbicki JR, Yekebas EF, Strate T, Eisenberger CF, Hosch SB, Steffani K, Knoefel WT. Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited. Ann Surg 2002; 236(1): 82-9. [PMID: 12131089]

Wang L, Liu GJ, Chen YX, Dong HP, Wang LX. Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion. Med Princ Pract 2012; 21(1):20-3. [PMID: 22024761]

Kokabi N, Lee E, Echevarria C, Loh C, Kee S. Sinistral portal hypertension: presentation, radiological findings, and treatment options - a case report. J Radiol Case Rep 2010; 4(10):14-20. [PMID: 22470692]

Rösch W, Lux G, Riemann JF, Hoh L. [Chronic pancreatitis and the neighboring organs]. Fortschr Med 1981; 99(29): 1118-21. [PMID: 7262798]

Patrono D, Benvenga R, Moro F, Rossato D, Romagnoli R, Salizzoni M. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization. Int J Surg Case Rep 2014; 5(10): 652-5. [PMID: 25194596]

Köklü S, Coban S, Yüksel O, Arhan M: Left-sided portal hypertension. Dig Dis Sci 2007; 52: 1141–1149.

Agarwal AK, Raj Kumar K, Agarwal S, Singh S. Significance of splenic vein thrombosis in chronic pancreatitis. Am J Surg 2008; 196(2): 149-54. [PMID: 18585674]

Burbige EJ, Tarder G, Carson S, Eugene J, Frey CF. Colonic varices. A complication of pancreatitis with splenic vein thrombosis. Am J Dig Dis 1978; 23(8): 752-5. [PMID: 685944]

Liu Q, Song Y, Xu X, Jin Z, Duan W, Zhou N. Management of bleeding gastric varices in patients with sinistral portal hypertension. Dig Dis Sci 2014; 59(7): 1625-9. [PMID: 24500452]

Heider TR, Azeem S, Galanko JA, Behrns KE. The natural history of pancreatitis-induced splenic vein thrombosis. Ann Surg 2004; 239 (6): 876-80. [PMID: 15166967]

Chawla Y, Dilawari JB, Katariya S. Gallbladder varices in portal vein thrombosis. AJR Am J Roentgenol 1994; 162(3): 643-5. [PMID: 8109513]

Brown A, Malden E, Kugelmas M, Kortz E. Diagnosis of pancreatic duct-portal vein fistula; a case report and review of the literature. J Radiol Case Rep 2014; 8(3): 31-8. [PMID: 24967026]

Mensier A, Bounoua F, Beretvas G, Mosoi A, Dardenne S. Kissing gastric ulcers causing acute pancreatitis and portal biliopathy: what's the link? JOP 2013; 14(6): 646-8. [PMID: 24216552]

Janssen HL, Wijnhoud A, Haagsma EB, van Uum SH, van Nieuwkerk CM, Adang RP, Chamuleau RA, van Hattum J, Extrahepatic portal vein thrombosis: aetiology and determinants of survival. Gut 2001; 49 (5): 720-4. [PMID: 11600478]

Jourabchi N, McWilliams JP, Lee EW, Sauk S, Kee ST. TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach. Case Rep Radiol 2013; 2013: 635391. [PMID: 23401834]

Stefănescu H, Grigorescu M, Tanţău M, Badea R, Cormoş R. Portal biliopathy--a lesser known complication of portal hypertension. Case report and review of the literature. Rom J Gastroenterol. 2003; 12(4): 309-13. [PMID: 14726977]

Rana SS, Bhasin DK, Rao C, Singh K. Portal hypertensive biliopathy developing after acute severe pancreatitis. Endosc Ultrasound. 2013; 2(4): 228-9. [PMID: 24949402]

Dhiman RK, Behera A, Chawla YK, Dilawari JB, Suri S. Portal hypertensive biliopathy. Gut. 2007; 56(7): 1001-8. [PMID: 17170017]

Ralls PW, Mayekawa DS, Lee KP, Colletti PM, Johnson MB, Halls JM. Gallbladder wall varices: diagnosis with color flow Doppler sonography. J Clin Ultrasound. 1988; 16(8): 595-8. [PMID: 3152408]

Ravikumar H, Singh J, Kalyanpur A. Transient Hepatic Attenuation Difference (Thad) - A Case Report. Ind J Radiol Imag 2006; 4: 441-444.

Wong H, Desser TS, Jeffrey RB. Transient Hepatic Attenuation Differences in Computed Tomography from Extrahepatic Portal Vein Compression. Radiology Case Reports 2008; 3:113.

Chen WP, Chen JH, Hwang JI, Tsai JW, Chen JS, Hung SW, Su YG, Lee SK. Spectrum

of transient hepatic attenuation differences in biphasic helical CT. AJR Am J Roentgenol. 1999; 172(2): 419-24. [PMID: 9930795]

Colagrande S, Centi N, Galdiero R, Ragozzino A. Transient hepatic intensity differences: part 1, Those associated with focal lesions. AJR Am J Roentgenol 2007; 188(1): 154-9. [PMID: 17179358]

Colagrande S, Centi N, La Villa G, Villari N. Transient hepatic attenuation differences. AJR Am J Roentgenol. 2004; 183(2): 459-64. [PMID: 15269041]

Gallix BP, Reinhold C, Dauzat M, Bret PM. Streamlined flow in the portal vein: demonstration with MR angiography. J Magn Reson Imaging 2002; 15(5): 603-9. [PMID: 11997903]

Patil PV, Khalil A, Thaha MA. Splenic parenchymal complications in pancreatitis. JOP. 2011; 12(3): 287-91. [PMID: 21546711]

Purushothaman K, Borowski DW. Unusual presentation of spontaneous splenic haematoma due to severe pancreatitis: a cautionary tale. BMJ Case Rep 2012. [PMID: 23148400]

Mujtaba G, Josmi J, Arya M, Anand S. Spontaneous splenic rupture: a rare complication of acute pancreatitis in a patient with Crohn's disease. Case Rep Gastroenterol. 2011; 5(1): 179-82. [PMID: 21552441]

Kim YI, Choe KJ, Choi KW. Ischemic jejunal stenosis following acute pancreatitis with mesenteric panniculitis. Korean J Gastroenterol 1991; 23: 930-935.

Cho YD, Hong SJ, Moon JH, et al. Stenosis of the colon due to chronic pancreatitis mimicking colon cancer. Korean J Gastrointest Endosc 1998; 18: 605-610.

Katz P, Dorman MJ, Aufses AH Jr. Colonic necrosis complicating postoperative pancreatitis. Ann Surg 1974; 179(4): 403-5. [PMID: 4815897]

Nottle P. Colonic infarction and pancreatitis: a case report. Aust N Z J Surg 1980; 50(2): 184-5. [PMID: 6930238]

Chai JY, Yun SI, Bae SS, Chae HB, Park SM, Youn SJ, Park JW, Bae IH, Kim SH, Song HG, Wang JH. [A case of jejunal infarction and perforation due to acute pancreatitis.. Korean J Gastroenterol 2004; 43: 120-4. [PMID: 14978369]

Griffiths RW, Brown PW Jr. Jejunal infarction as a complication of pancreatitis. Gastroenterology. 1970; 58(5): 709-12. [PMID: 5444175]

Raza SS, Hakeem A, Sheridan M, Ahmad N. Spontaneous pancreatic pseudocyst-portal vein fistula: a rare and potentially life-threatening complication of pancreatitis. Ann R Coll Surg Engl 2013; 95: e7-9. [PMID: 23317711]

Delcenserie R, Bental A, Goll A, Butel J, Dupas JL. [Pancreatic-portal fistula and subcutaneous fat necrosis]. Gastroenterol Clin Biol. 1994; 18(12): 1132-7. [PMID: 7750687]

Rabache A, Crinquette JF, Vermersch A, Cuingnet P, Maunoury V, Hanon D, Lescut J. [Pancreatic-portal fistula. A rare complication of chronic pancreatitis]. Gastroenterol Clin Biol 1994; 18(12): 1138-41. [PMID: 7750688]

Hammar AM, Sand J, Lumio J, Hirn M, Honkonen S, Tuominen L, Nordback I. Pancreatic pseudocystportal vein fistula manifests as residivating oligoarthritis, subcutaneous, bursal and osseal necrosis: a case report and review of literature. Hepatogastroenterology 2002; 49(43): 273-8. [PMID: 11941974]

Dawson BC, Kasa D, Mazer MA. Pancreatic pseudocyst rupture into the portal vein. South Med J 2009; 102(7): 728-32. [PMID: 19561436]

Skarsgard ED, Ellison E, Quenville N. Spontaneous rupture of a pancreatic pseudocyst into the portal vein. Can J Surg 1995; 38(5): 459-63. [PMID: 7553473]

Packeisen J, Klingen D, Grezella F. Spontaneous rupture of a pancreatic pseudocyst into the portal vein. Z Gastroenterol 2001; 39(11): 961-4. [PMID: 11778155]

Kim HS, Hong SH, Park HS, Lee ES, Kang IW. Hepatic Infarction Complicating Acute Pancreatitis: A Case Report. J Korean Radiol Soc 2000; 43(1): 73-76.

Kim BC, Joo KR, Lee HS, Jeong YK, Suh HS, Kim DH, Park NH, Park JH. A Case of Chronic Pancreatitis Associated with Liver Infarction and Acrodermatitis Enteropathica. Korean J Intern Med 2002; 17(4): 263-5. [PMID: 12647643]

Maruyama M, Yamada A, Kuraishi Y, Shibata S, Fukuzawa S, Yamada S, Arakura N, Tanaka E, Kadoya M, Kawa S. Hepatic Infarction Complicated with Acute Pancreatitis Precisely Diagnosed with Gadoxetate Disodium-enhanced Magnetic Resonance Imaging. Intern Med 2014; 53(19): 2215-21. [PMID: 25274233]

Walsh TJ, Eggleston JC, Cameron JL. Portal hypertension, hepatic infarction, and liver failure complicating pancreatic islet autotransplantation. Surgery 1982; 91(4): 485-7. [PMID: 6801798]

Parikh H, Shukla A, Aswani Y, Bhatia S. Multiple extrasplanchnic venous thromboses: a rare complication of pancreatitis. A case report. JOP 2012; 13(3): 317-9. [PMID: 22572142]

Stringer MD, Michell M, McIrvine AJ. Inferior vena caval thrombosis complicating acute pancreatitis. Case report. Acta Chir Scand 1988; 154(2): 161-3. [PMID: 3354298]

Peillon C, Manouvrier JL, Testart J. Inferior vena cava thrombosis secondary to chronic pancreatitis with pseudocyst. Am J Gastroenterol 1991; 86(12): 1854-6. [PMID: 1962640]

Zhang Q, Zhang QX, Tan XP, Wang WZ, He CH, Xu L, Huang XX. Pulmonary embolism with acute pancreatitis: a case report and literature review. World J Gastroenterol 2012 14; 18(6): 583-6. [PMID: 22363127]

Mukund A, Gamanagatti S, Saraya A. Chronic pancreatitis causing thrombotic occlusion of IVC and renal veins. Trop Gastroenterol 2013; 34(1): 39-41. [PMID: 23923375]

Ohta H, Hachiya T. A case of inferior vena cava thrombosis and pulmonary embolism secondary to acute exacerbation of chronic pancreatitis: a rare finding in radionuclide venography. Ann Nucl Med 2002; 16(2): 147-9. [PMID: 12043910]

Molacek J, Treska V, Baxa J, Duras P, Vesely V. Phlegmasia cerulea dolens as a complication of a severe form of acute hemorrhagic-necrotizing pancreatitis. Blood Coagul Fibrinolysis. 2008; 19(1):98-100. [PMID: 18180625]

Charvat F, Maskova J, Belina F, Buric I, Lacman J, Fuksa Z, Vrana J. Portal vein erosion: a rare hemorrhagic complication of acute pancreatitis treated by percutaneous stent-graft placement. J Vasc Interv Radiol. 2010; 21(3):411-2. [PMID: 20171562]

Lacman J, Buric I, Charvát F, Masková J, Fuksa Z, Pudil J, Belina F. [Multidisciplinary cooperation in the management of serious bleedings complicating necrotizing pancreatitis--a case review]. Rozhl Chir. 2008; 87(10): 507-11. [PMID: 19110942]

Müller CH, Lahnert U, Schafmayer A, Lankisch PG. Massive intraperitoneal bleeding from tryptic erosions of the splenic vein. Another cause of sudden deterioration during recovery from acute pancreatitis. Int J Pancreatol. 1999; 26(1): 49-52. [PMID: 10566158]

Dixon JM, Armstrong CP, Eremin O.Varicocele caused by a pancreatic pseudocyst.Gut 1983; 24(5): 438-40. [PMID:6840618]

Aswani Y, Hira P. Secondary Varicocele Caused by Pancreatic Pseudocyst Obstructing Testicular Venous Drainage. JOP. J Pancreas (Online) 2013; 14(6): 674-675. [PMID: 24216560]

Dilated venous channels in the wall of gallbladder at sonogram
Published
2015-01-31
How to Cite
Aswani, Y., & Hira, P. (2015). Venous Complications of Pancreatitis: A Review. JOP. Journal of the Pancreas, 16(1), 20-24. https://doi.org/10.6092/1590-8577/2889