Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

Complete traumatic laceration of the superior mesenteric vein after a blunt abdominal injury in a pediatric patient

BACKGROUND

Isolated injury to the superior mesenteric vein (SMV) caused by blunt abdominal trauma is rare but often lethal, especially in pediatric patients. Due to the low incidence of SMV injuries, there are no universal guidelines for its diagnosis and treatment. The diagnosis is made using either computed tomography (CT) or intraoperative exploration. Primary vascular repair is recommended.

CASE REPORT

A 10-year-old girl was transferred to a trauma center after a high-energy motor vehicle collision. Under the diagnosis of acute abdomen with hemoperitoneum, the patient underwent urgent laparotomy, 34 min after admission to the hospital. A complete laceration of the SMV trunk was observed. Definitive vascular repair of the transected SMV was performed. An interposition graft from the internal jugular vein was used with a good postoperative course.

CONCLUSION

This case report demonstrates that definitive vascular repair of the SMV reduces the risk of intestinal ischemia and should be performed in cases where ligation presents a real threat to small bowel viability. In cases of severe SMV injury, the internal jugular vein is a high-quality and easily accessible graft.

Systemic Thrombolysis for Isolated Splenic Vein Thrombosis Secondary to Oral Contraceptives: A Case Report

Isolated splenic vein thrombosis (ISVT) is a very rare venous thromboembolism in the absence of pancreatic diseases, which can cause acute abdominal pain and chronic left-side portal hypertension. Herein, we reported a 40-year-old female patient who developed ISVT after taking oral contraceptives. Anticoagulation with oral rivaroxaban was the first-line choice of therapy in this case. Since then, abdominal pain alleviated, but she did not achieve vessel recanalization. Thus, a 7-day systemic thrombolysis with urokinase was given. Abdominal pain disappeared, but ISVT was not significantly improved. During follow-up period, long-term anticoagulation with oral rivaroxaban was given. Collectively, this case indicates the possibility of oral contraceptives as a risk factor of ISVT as well as anticoagulation combined with systemic thrombolysis as a choice of treatment for ISVT. Certainly, long-term follow-up is necessary in this case.

A narrative review of acute pancreatitis-induced splanchnic vein thrombosis: from pathogenesis to clinical management

Acute pancreatitis-induced splanchnic vein thrombosis (APISVT) is an important sequela complication of acute pancreatitis, which may cause poor prognosis, such as severe gastrointestinal hemorrhage, bowel ischemic necrosis and liver failure. However, its mechanism remains uncertain, and there is not a general consensus on the management. In this study, we reviewed the latest academic publications in APISVT, and discussed its pathogenesis, clinical presentation, adverse outcome and treatment, especially focused on the role of anticoagulant therapy. It was indicated that anticoagulation therapy can significantly elevate thrombus recanalization and reduce the incidence of complications and mortality with no increase of bleeding. Actually, as most of these studies were retrospective analyses and prospective studies included small samples, the conclusion remains controversial. Thus, well-designed randomized controlled trials are urged to verify the effectiveness and safety of anticoagulation therapy for APISVT.