Splanchnic venous thrombosis in necrotizing pancreatitis: recanalization and the effectiveness of anticoagulant therapy.

OBJECTIVE

Splanchnic venous thrombosis (SVT) is a common complication in necrotizing pancreatitis (NP), contributing significantly to increased morbidity and mortality. The role of anticoagulant therapy in the management of SVT remains controversial. This study aims to identify the factors influencing SVT formation and recanalization in patients with NP and to evaluate the efficacy of anticoagulant treatment.

MATERIALS AND

METHODS

A retrospective analysis was conducted on 121 patients diagnosed with NP between July-2013 and August-2022. Sociodemographic and clinical characteristics, comorbidities, anticoagulant use, and computed tomography findings at admission, first week, first month, third month, sixth month, and first-year follow-ups were evaluated.

RESULTS

SVT was detected in 51 of 121 (42.1%) patients with NP. Thrombosis incidence correlated with higher computed tomography severity index (CTSI) scores. The splenic vein was the most frequent site of thrombus formation. Among patients with SVT, recanalization was observed in 18 of 51 (35.3%) patients. Recanalization rates were significantly lower in cases of total occlusions than partial occlusions (p < 0.001). Diabetes mellitus was associated with lower recanalization rates (p = 0.019). No significant association was found between therapeutic-dose anticoagulant therapy and thrombosis formation (p = 0.239) or recanalization (p = 0.438).

CONCLUSION

Clinical course of necrotizing pancreatitis is a dynamic and complex process and SVT is strongly associated with both the severity and persistence of inflammation. Recanalization primarily depends on the resolution of inflammation, and therapeutic-dose anticoagulant therapy does not appear to provide significant benefit. Diabetes mellitus negatively affects recanalization outcomes. Total occlusion makes recanalization more difficult.