Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis
A. L. Warshaw, G. L. Jin and L. W. Ottinger
While splenic vein obstruction is a well-described feature of chronic
pancreatitis, analogous occlusion of the superior mesenteric and/or portal
veins (SMV-PV) has not been appreciated. We present 14 instances of SMV-PV
obstruction in patients with proved chronic pancreatitis without cancer.
Portal hypertension was first suspected because of variceal bleeding (4/14)
or unexpected varices at laparotomy (10/14). The angiographic appearance
mimicked that of pancreatic cancer. The splenic vein was also occluded in
eight of the 13 patients who had angiograms. The liver was normal in all 14
cases. The clinical importance of SMV-PV occlusion in chronic pancreatitis
lies in (1) its presentation by variceal bleeding, (2) the probable
necessity for nonshunting means of control for bleeding varices, (3) the
increased difficulty of operations on the pancreas because of portal
hypertension, and (4) the possible confusion with pancreatic cancer.
