Splanchnic vein thrombosis in acute pancreatitis: a review of treatment indications, methods, and outcomes in a single institution.

BACKGROUND: Splanchnic vein thrombosis (SVT) is a well-recognized complication of acute pancreatitis. The question of whether or not to treat SVT with systemic therapeutic anticoagulation (STA) remains to be seen. The universal use of anticoagulation may lead to an increased risk of bleeding complications associated with acute pancreatitis. Literature on this subject is sparse and there is no clear guideline on how to treat SVT. Our research demonstrates local practice where therapeutic anticoagulation in SVT varies. METHODS: A retrospective review of patients presenting with acute pancreatitis admitted over a five-year period to a single tertiary hospital with splanchnic vein thrombosis was performed. RESULTS: Of the 1408 patients admitted with acute pancreatitis, 42 were diagnosed with splanchnic vein thrombosis, with a male dominance of 34 (81%). A total of 25 patients received anticoagulation. The use of anticoagulation was dependent on the location of the thrombus, P < 0.01. Anticoagulation use was most common in cases of combination mesenteric, splenic, and portal vein thrombus (100%), isolated mesenteric vein (100%), isolated portal vein (89%), combination portal and splenic vein (87%), and combination mesenteric and splenic vein (75%). The rate of anticoagulation use was lowest in isolated splenic vein thrombus (23%). CONCLUSION: The early commencement of STA in patients with acute pancreatitis and triple-vessel SVT or with portal vein involvement is supported by our data. Isolated splenic vein thrombus does not require systemic therapy. Further research is needed to establish a clear clinical guideline.

Characteristics of kangaroo-related motor vehicle crashes.

BACKGROUND: Kangaroo-related motor vehicle collisions are common but there is limited literature on this topic. Drivers confronted by kangaroos may choose to swerve or to directly collide with the kangaroo. The effect of these differing crash mechanisms, along with the effect of vehicle type or time of day, has not yet been reported. METHODS: A retrospective cohort study was performed, examining patients admitted to our tertiary trauma centre for kangaroo-related motor vehicle collisions between 2000 and 2020. Data on patient demographics, crash characteristics, and hospital stay were collected and analysed. RESULTS: A total of 366 patients were included and were predominantly male (76%) with an median age of 40. Swerve crashes were more common (59%) than direct impact and swerving was a statistically significant predictor of reduced injury severity score on multivariable analysis (other significant factors were female sex and no rollover). Motor vehicle crashes and motorbike crashes had differing crash characteristics. Motor vehicle crashes were more likely the result of swerving, and swerving was less likely to cause ejection or require extrication but more likely to cause rollover. Motorbike crashes however, were more likely the result of head on collision and riders were more likely to be ejected from the vehicle, require extrication, or be involved in a rollover. In terms of time of day, there were more crashes at dawn and there was a trend towards higher injury severity score and length of stay for night-time crashes. CONCLUSION: For kangaroo-related motor vehicle crashes, predictors of increased injury severity score on multivariable analysis were male sex, direct impact, and rollover. Motorbikes and motor vehicles had differing crash mechanisms and characteristics, as did night-time crashes when compared to daytime or twilight crashes. LEVEL OF EVIDENCE: IV, prognostic.