Venous Thrombosis Complicating Acute Pancreatitis.

Most cases of pancreatitis are mild and self limited. On the other hand, approximately one quarter of patients with pancreatitis may develop vascular complications. Pancreatitis in combination with vascular complications is dangerous and potentially lethal. The survival of patients with pancreatitis and vascular complications depends on the early diagnosis of these complications. We report a case of an elderly male patient who had recurrent pancreatitis. On radiological imaging, patient was found have portal vein, splenic vein and superior mesenteric vein thrombosis. Patient recovered after emergent and timely management. The article focuses on the aspects of etiology, pathogenesis, diagnosis and management of acute pancreatitis with venous thrombosis.

Management of Venous Thrombosis in Atypical Location / 대한내과학회지

Venous thrombosis in atypical locations means thrombosis of upper extremity deep vein, cerebral venous sinus, splanchnic vein including portal, hepatic, mesenteric and splenic vein, renal vein, ovarian vein and retinal vein. This thrombosis rarely occurred and could be affected by the involved organ when compared to the incidence and cause of deep vein thrombosis in lower extremity with or without pulmonary embolism. There is a limitation to perform a large-scaled randomized trial for these rare conditions, and several recommendations based on results of small-sized studies and observational registries are available now. Therefore, we need multi-department and international collaboration to test the efficacy and safety of anticoagulation including new oral anticoagulants in the treatment of venous thrombosis in atypical locations.

Prevalence of JAK2V617F mutation in intra-abdominal venous thrombosis.

Background and aim: Myeloproliferative disorders (MPD) (like polycythemia vera, essential thrombocythemia and primary myelofibrosis) are responsible for 50% cases of Budd-Chiari syndrome (BCS) and 35% cases of portal venous thrombosis (PVT) in western series. A point mutation at Val617Phe of Janus kinase 2 tyrosine kinase gene (JAK2V617F mutation) occurs in high proportion with MPD. This may be useful in diagnosing overt and latent form of MPD in intra-abdominal venous thrombosis (IAVT), consisting of BCS and PVT. Methods: In a 4 year prospective study from 2006 to 2009, JAK2 mutations were assessed in all patients diagnosed with MPD and IAVT attending our institution. Twenty three healthy individuals and 31 patients with non-MPD hematological disorders served as controls. All patients of idiopathic IAVT were tested for the mutation. Test for JAK2V617F mutation was carried out by allele specific polymerase chain reaction. Results: JAK2 V617F mutation was significantly more common in MPD patients (76%) than in non-MPD hematological disorders (0%) and healthy controls (0%). There was no statistical difference in presence of JAK2V617F mutation in patients of MPD with or without thrombosis (80% vs. 74%). In 58 patients with IAVT, the JAK2V617F mutation was present in 40%with BCS, 14% with PVT and 100% combined BCS+PVT). Conclusions: The JAK2V617F mutation occurs at high frequency in patients with MPD and IAVT. All idiopathic IAVT patients must be screened for JAK2V617F mutation to detect latent MPD. Detection of latent MPD by JAK2V617F mutation in BCS may change treatment strategy and outcome.