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Forum Name: Gastroenterology Topics

Question: splenic vein thrombosis


 neo - Mon Apr 27, 2009 2:41 am

I HAVE BEEN A CHRONIC PANCREATITIS PATIENT SINCE 2001. THE PAIN HAS BEEN UNDER CONTROL FOR PAST 5 YEARS. MY WEIGHT IS 56 KG & UNDERWEIGHT BY 14 KG, AND HAVE DIFFICULTY IN DIGESTING NORMAL FOOD HENCE I ALWAYS FEEL TIRED.
I UNDERWENT A CT SCAN ON 24/04/09. THE REPORT IS AS FOLLOWS :
DATE: 24 April 2009
CT SCAN OF THE ABDOMEN AND PELVIS WAS PERFORMED WITH AND WITHOUT I.V. CONTRAST ENHANCEMENT.
64 slice volume CT of Abdomen and pelvis was performed starting from the Domes of diaphragm upto the ischiorectal fossa.
Intravenous contrast enhancement was done using 80ml of Non Ionic contrast 300mg
There is diffuse dilatation of the pancreatic duct which measures upto maximum of 8mm. There are multiple intraductal calculi along with calcifications in the parenchyma.
Diffuse atrophy of the pancreatic parenchyma also noted.
There is a cyst in the pancreatic duodenal ligament immediately posterior to the gastro duodenal artery. It shows thick wall and measures 1.5cms in diameter. Subtle enhancement of the wall is noted.
There is another irregular rim enhancing hypo dense area around the distal body and tail of pancreas and in contact with the left anterior Para renal fascia. It is surrounded by ill-defined soft tissue density. There are multiple subcentimeter lymph nodes in the gastrohepatic, celiac axis, periportal and peripancreatic regions.
Diffuse thickening of the left anterior Para renal fascia is noted.
The biliary tree is not dilated and the Gall bladder is unremarkable. The Liver is unremarkable. The portal vein shows normal enhancement and measures 1.7cms in diameter. The splenic vein is thrombosed and there are multiple collateral vessels in the abdomen, most predominant around the spleen and left kidney.
The spleen, both adrenal glands, kidneys and urinary bladder are unremarkable.
The suprarenal IVC is small in caliber and shows subtle enhancement.
IMPRESSION:
THERE IS CHRONIC PANCREATITIS WITH CHARACTERISTICS AS DESCRIBED IN THE TEXT ALONG WITH SMALL PERIPANCREATIC COLLECTIONS WITH LOCATION AND EXTENT AS ELABORATED IN THE TEXT.
THERE IS SPLENIC VEIN THROMBOSIS WITH PORTAL HYPERINTENSION AND MULTIPLE ABDOMINAL COLLATERAL VESSELS. UPPER ABDOMINAL SUB CENTIMETER LYMPH NODES ARE SEEN AS DESCRIBED.
IN COMPARISON WITH THE PREVIOUS CT OF 30th JULY 2008, SHOW NO SIGNIFICANT CHANGES.

PLEASE TELL ME THE BEST COURSE OF TREATMENT. I don't WANT TO CONSIDER SURGERY AT THIS JUNCTURE. IF THE INFORMATION GIVEN IS INSUFFICIENT PLEASE SAY SO, I SHALL GIVE FURTHER INFORMATION AS REQUIRED.
 John Kenyon, CNA - Thu May 14, 2009 10:26 pm

User avatar Hello --

If you are asking the course of treatment only for splenic vein thrombosis (the chronic pancreatitis is a common cause and is being managed appropriately I would assuem), the first line is observation, not surgery. While a minority of patients may eventually experience GI bleeding from varicose veins in the tract, this is usually managed by sclerotic therapy in a minimally invasive setting and rarely recurs. There is potential, with removal of the spleen, to resolve the problem entirely, but this is controversial and only recommended for patients who are already undergoing laparotomy for some other reason, in which case it is considered useful to take the spleen at that time. Otherwise, primarily you will be followed normally and if you should experience gastric variceal bleeding it would be treated via endoscopic sclerotherapy. Splenic vein thrombosis is rarely a critical issue, and with proper observation complicatons can be managed most often without any radical steps taken.

I hope this is helpful. Good luck to you and do follow up with us here as needed.

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