Portal vein
thrombosis (PVT) is a relatively common complication in patients with
liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic
chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with
danaparoid sodium at first, but the
thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic
intravenous infusion of
urokinase and
heparin was performed to prevent further progression of the
thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a
pancreatic pseudocyst and caused intractable
pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a
stent in the pancreatic duct, which completely cured the
pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a
fistula was detected between the
pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from
pancreatitis but also a
fistula between the pancreatic duct and the splenic vein.