Splanchnic vein thrombosis (SVT) is an uncommon but clinically significant complication of acute pancreatitis, attributed to local inflammation and a transient hypercoagulable state. Superior mesenteric vein (SMV) thrombosis is particularly concerning because of its association with bowel ischemia and long-term portal venous complications. Optimal management strategies remain incompletely defined, particularly regarding the role and timing of anticoagulation. We report the case of a 36-year-old woman with acute alcohol-induced pancreatitis complicated by non-occlusive SMV thrombosis extending toward the portal vein. The diagnosis was established using contrast-enhanced computed tomography (CT) and confirmed by magnetic resonance imaging. The patient was successfully treated with unfractionated heparin followed by transition to a direct oral anticoagulant, with clinical and biochemical improvement. This case highlights the importance of early recognition of vascular complications in acute pancreatitis and supports consideration of anticoagulation in carefully selected patients to prevent thrombus progression and potential ischemic complications.
Mushtaq et al. (Tue,) studied this question.