To investigate the clinical manifestations, diagnosis and treatment of acute pancreatitis complicated with regional portal hypertension (RPH).

Clinical data of 9 patients with acute pancreatitis complicated with RPH admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to January 2021 were retrospectively analyzed. Among them, 8 patients were male and 1 female, aged (42±16) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. Clinical manifestation, laboratory examination, imaging examination, diagnosis, treatment and follow-up were analyzed.

The incidence of acute pancreatitis complicated with RPH was 3.8%(9/236). The number of previous occurrence of pancreatitis was 2.7±1.1. The time interval from the initial onset of pancreatitis was 67(21-365) d. 2 cases were diagnosed with biliary origin of pancreatitis, 6 cases with hypertriglyceridemia-induced pancreatitis and 1 case with alcohol-induced pancreatitis. 7 patients were diagnosed with moderately severe acute pancreatitis and 2 cases with severe acute pancreatitis. Clinical manifestations consisted of splenomegaly in 9 cases, anemia in 6, abdominal pain in 4 and upper gastrointestinal bleeding in 2. Abdominal contrast-enhanced CT scan showed splenomegaly in 9 cases, splenic hilar varices in 6, gastric fundus-gastric varices in 6, isolated gastric fundus varices in 2 and ascites in 1. 6 patients were complicated with pancreatic pseudocysts, including 3 cases of encapsulated pancreatic necrosis, 3 cases of infectious pancreatic necrosis and 1 case of splenic vein thrombosis. 5 cases underwent open distal pancreatectomy + splenectomy, and 1 of them received resection of pancreatic necrotic tissues. 1 case underwent laparoscopic distal pancreatectomy + splenectomy. 1 case repeatedly underwent minimally invasive removal of retroperitoneal necrotic tissues and drainage. Due to abdominal hemorrhage induced by rupture of splenic artery pseudoaneurysm, 1 case underwent emergent celiac arteriography embolization, followed by open distal pancreatectomy + splenectomy. 1 case underwent open drainage of encapsulated pancreatic necrosis + splenectomy. Postoperatively, Grade A pancreatic fistula was observed in 2 cases and 1 case of gastrointestinal dysfunction, which were cured after symptomatic supportive therapy. During postoperative follow-up, no gastrointestinal bleeding was reported. 1 case developed from type 2 diabetes mellitus and 1 case of digestive dysfunction.

RPH is a rare and severe complication of acute pancreatitis. Anemia and gastrointestinal bleeding are the most common clinical manifestations. Gastroscopy and enhanced CT scan are important ways to confirm the diagnosis. Management of local pancreatic complications is the core of treatment. Splenectomy is a safe and efficacious method.