To determine the natural history of pancreatitis-induced splenic vein thrombosis with particular attention to the risk of gastric variceal hemorrhage.
Previous studies have suggested that splenic vein thrombosis results in a high likelihood of gastric variceal bleeding and that splenectomy should be performed to prevent hemorrhage. Recent improvements in cross-sectional imaging have led to the identification of splenic vein thrombosis in patients with minimal symptoms. Our clinical experience suggested that gastric variceal bleeding in these patients was uncommon.
A computerized index search from 1993 to 2002 for the medical records of patients with a diagnosis of pancreatitis was performed. Fifty-three patients with a diagnosis of pancreatitis and splenic vein thrombosis were identified. The medical records of these patients were reviewed, and follow-up was completed, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ).
Gastrosplenic varices were identified in 41 patients (77%) with varices evident on computed tomography (CT) in 40 of 53 patients, on esophagogastroduodenoscopy (EGD) in 11 of 36 patients, and on both CT and EGD in 10 of 36 patients. This risk of variceal bleeding was 5% for patients with CT-identified varices and 18% for EGD-identified varices. Overall, only 2 patients (4%) had gastric variceal bleeding and required splenectomy. Functional quality of life was better than historical controls surgically treated for chronic pancreatitis.
Gastric variceal bleeding from pancreatitis-induced splenic vein thrombosis occurs in only 4% of patients; therefore, routine splenectomy is not recommended.
With improved cross-sectional imaging, pancreatitis-induced splenic vein thrombosis is diagnosed with increasing frequency. In the past, splenectomy was performed to prevent gastric variceal bleeding, but the present study suggests that the risk of hemorrhage is low and that routine splenectomy is not necessary.
From the *Department of Surgery, Division of Gastrointestinal Surgery, and Center for Pancreatic and Biliary Disorders, and the †Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Reprints: Kevin E. Behrns, MD, Division of Gastrointestinal Surgery, CB#7081, 320 Medical Wing E, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7081. E-mail: Kevin_Behrns@med.unc.edu.