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Development of splanchnic venous thromboses is a known consequence of pancreatitis, most commonly of the splenic vein. As development of venous thromboses is an uncommon complication of acute recurrent pancreatitis or chronic pancreatitis, there is limited evidence for detection and management. This pediatric recurrent pancreatitis case series demonstrates detection of splenic vein thromboses with subsequent treatment with therapeutic injectable anticoagulation, and then transition to oral anticoagulation with resolution of the thromboses at follow up.

Case 1

A 13-year-old female with obesity (BMI 99th percentile) and a family history of hereditary pancreatitis presented with her second episode of acute pancreatitis and was started on prophylactic enoxaparin upon admission. On hospital day 6, an abdominal CT showed development of a nonocclusive splenic vein thrombosis and the enoxaparin was increased to therapeutic doses. The patient’s anticoagulation was changed to oral rivaroxaban prior to discharge, which she maintained for several weeks. Follow up ultrasound three months after discharge demonstrated resolution of the splenic vein thrombosis.

Case 2

A 9-year-old female with obesity (BMI 99th percentile) presented with her third episode of acute pancreatitis requiring IV fluids and opioids for pain management. On hospital day 3, an abdominal CT showed significant worsening of necrotizing pancreatitis involving the entire pancreas and an occlusive splenic vein thrombosis. She was subsequently initiated on therapeutic enoxaparin. Due to severe needle phobia during hospitalization demonstrated while receiving her twice daily enoxaparin injections, she was switched to oral rivaroxaban at discharge. A follow up CT scan five months later revealed near complete resolution of the extensive splenic thrombosis.


Direct oral anticoagulants (DOACs) should be considered in pediatric patients with pancreatitis-induced thrombosis (PIT) over low-molecular-weight heparin as they have been shown to be as efficacious and safe in the treatment of thromboses in other clinical conditions and are more likely to be more acceptable to the pediatric patient with pancreatitis. Furthermore, the use of DOACs in PIT is an area in critical need for research.

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Gastroenterology | Pediatrics

Direct Oral Anticoagulant Use in Pediatric Pancreatitis-Induced Thromboses; a Case Series