Chronic Pancreatitis with Portal Venous Thrombosis in a Child: Difficult Scenario for Surgery.

Chronic pancreatitis in children is uncommon but may be complicated by portal vein (PV) thrombosis and extrahepatic portal hypertension (EPH). This association poses significant diagnostic and therapeutic challenges. We report a 12-year-old boy with chronic calcific pancreatitis complicated by EPH secondary to PV thrombosis. He presented with recurrent abdominal pain, nonbilious vomiting, hypersplenism, and variceal bleeding. Imaging revealed a portal cavernoma with thrombosed PV, dilated splenic vein, atrophic pancreas, and ductal calculi. The patient underwent splenectomy with proximal splenorenal shunt and lateral pancreaticojejunostomy in a single sitting. Postoperative recovery was uneventful. At 8 months follow-up, the shunt remained patent, and the patient was asymptomatic apart from one self-limiting pain episode. Recurrent pancreatitis with EPH in children is rare. A multidisciplinary, individualized approach with careful preoperative optimization and tailored surgery can achieve good outcomes.