Two Pediatric Patients with Splanchnic Venous Thrombosis as a Complication of Acute Pancreatitis Successfully Treated with Low-Molecular-Weight Heparin and Rivaroxaban

Shannon Capraro, Melissa Acquazzino, Mary Drake, Chinenye R. Dike

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective: Background: Case Reports: Conclusions: Unusual clinical course Splanchnic venous thrombosis is a known complication of pancreatitis in children and can involve the splenic, portal, or superior mesenteric veins, either in isolation or in combination. However, diagnosis and management of thrombosis following pancreatitis remains controversial, especially regarding the use of anticoagulants for management. Here, we present the cases of 2 children who developed splanchnic vein thrombosis involving the splenic vein during attacks of pancreatitis and who were successfully treated with direct oral anticoagulants. Case 1: A 13-year-old girl presented with a second attack of acute pancreatitis. She developed a non-occlu-sive splenic vein thrombosis diagnosed by CT scan on the sixth day of hospitalization. Injectable low-molecu-lar-weight heparin was started during hospitalization and switched to oral rivaroxaban at discharge. Imaging at follow-up showed resolution of thrombosis. Case 2: A 9-year-old girl with history of acute recurrent pancreatitis presented with a third attack of acute pan-creatitis. An occlusive splenic vein thrombosis with extension into the portal vein and superior mesenteric vein and necrotizing pancreatitis was seen on CT scan on the third day of hospitalization. Low-molecular-weight heparin was initiated during hospitalization and was switched to oral rivaroxaban at discharge. Imaging at fol-low-up demonstrated nearly complete resolution of the extensive thrombosis. Splanchnic venous thrombosis remains a rare complication of pediatric pancreatitis. Anticoagulant use in patients with these complications remains controversial. Direct oral anticoagulants are as safe and effective as low-molecular-weight heparin and should be considered for use in children instead of low-molecular-weight heparin due to its advantages, including the availability of enteral forms of administration.

Original languageEnglish (US)
Article numbere937599
JournalAmerican Journal of Case Reports
Volume23
DOIs
StatePublished - 2022

Keywords

  • Anticoagulants
  • Pancreatitis
  • Pediatrics
  • Venous Thrombosis

ASJC Scopus subject areas

  • General Medicine

Fingerprint

Dive into the research topics of 'Two Pediatric Patients with Splanchnic Venous Thrombosis as a Complication of Acute Pancreatitis Successfully Treated with Low-Molecular-Weight Heparin and Rivaroxaban'. Together they form a unique fingerprint.

Cite this