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  • Title: Venous Thromboembolism in Necrotizing Pancreatitis: an Underappreciated Risk.
    Author: Roch AM, Maatman TK, Carr RA, Colgate CL, Ceppa EP, House MG, Lopes J, Nakeeb A, Schmidt CM, Zyromski NJ.
    Journal: J Gastrointest Surg; 2019 Dec; 23(12):2430-2438. PubMed ID: 30734182.
    Abstract:
    BACKGROUND: Necrotizing pancreatitis (NP) is a severe systemic inflammatory process. We have observed a high incidence of venous thromboembolism (VTE) in NP patients. However, remarkably few data exist to document the true incidence of VTE-including splanchnic vein thrombosis (SVT), extremity deep venous thrombosis (eDVT), and pulmonary embolism (PE)-in NP. Therefore, we sought to determine the incidence and risk factors for VTE in NP patients. METHODS: Retrospective review of all NP patients treated at a single academic center between 2005 and 2015. VTE diagnosis was confirmed by ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and/or ventilation/perfusion (V/Q) scan. Descriptive statistics and univariate analysis were applied where appropriate; p value < 0.05 was considered statistically significant. RESULTS: Five hundred and forty-five NP patients (median age 53 years; 65% males) were reviewed. VTE was diagnosed in 312 patients (57%). SVT was found in 50%, eDVT in 16%, and PE in 6%. VTE in multiple sites was found in 22% of patients. VTE was diagnosed a median of 37 days following pancreatitis diagnosis. Seventy-nine percent of patients required at least one surgical procedure over the course of their NP. Patients requiring surgery had a DVT incidence of 58%; however, VTE was diagnosed preoperatively in 63%. Male gender, history of previous DVT, infected necrosis, development of organ failure, and development of respiratory failure were identified as risk factors for VTE (p = 0.001-0.04) by univariate analysis. CONCLUSIONS: Venous thromboembolism is extremely common in necrotizing pancreatitis. Regular ultrasound screening may be considered to facilitate early diagnosis in this extremely high-risk population.
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