Splenomegaly as a Reliable Sign of Splenic Vein Thrombosis in Patients with Acute Pancreatitis

Abstract

Research Question: In patients with acute pancreatitis who develop pancreatitis-induced splenic vein thrombosis (PISVT), is splenomegaly observed as a reliable sign?

Hypothesis: We predict that splenomegaly will not be observed as a reliable sign of pancreatitis-induced splenic vein thrombosis.

Background: Splenic vein thrombosis in patients with acute pancreatitis can lead to gastric and duodenal varices presenting as hematemesis and hemorrhage. Splenic vein thrombosis was only previously suspected in patients with splenomegaly. Treatment via splenectomy can be curative of varices that result from splenic vein obstruction. In patients with acute pancreatitis who develop pancreatitis-induced splenic vein thrombosis (PISVT), is splenomegaly observed as a reliable sign?

Methods: A retrospective review was conducted to evaluate patients with acute pancreatitis for the presence or absence of splenomegaly. Their sex, age, and platelet counts were also compared.

Results: 23 patients were identified with acute pancreatitis and splenic vein thrombosis, patients with cirrhosis were excluded. 8 patients had splenomegaly on CT and 15 patients did not have splenomegaly on CT. Mean platelet count was twice as high in the group without splenomegaly (304.2 +/- 146.6) as compared to the group with splenomegaly (151.1 +/- 36.9) (p = 0.015).

Conclusion: Pancreatitis-induced splenic vein thrombosis may or may not result in splenomegaly. Platelet count may be a useful adjunct in the evaluation of patient with pancreatitis induced splenic vein thrombosis which can lead to life-threatening varices if left untreated.