Transcatheter arterial embolization for postoperative intraperitoneal and gastrointestinal hemorrhage in a patient with severe acute pancreatitis

Pancreatitis is associated with pseudoaneurysm in 4-10% of patients. Intraperitoneal and gastrointestinal hemorrhage resulting from rupture of a pseudoaneurysm is an uncommon complication of pancreatitis. We report a male with severe acute pancreatitis presenting with intraperitoneal and gastrointestinal hemorrhage 13 days and 68 days after debridement and drainage of infected necrosis of pancreas, which were successfully managed by a transcatheter arterial embolization with "two points" [both sides of the bleeding point]. This case not only reveals the management of intraperitoneal and gastrointestinal hemorrhage, but also indicates "two points" embolization could be the definitive therapy for hemorrhage secondary to severe acute pancreatitis

Management of postoperative acute intraperitoneal and gastrointestinal hemorrhage in patients with severe acute pancreatitis

Acute intraperitoneal and gastrointestinal hemorrhage [AIGH] is a fatal postoperative complication of severe acute pancreatitis [SAP]. Prompt diagnosis and correct treatment of AIGH remain a challenge. The current study presents the procedures undertaken by a single institution in managing postoperative AIGH in patients with SAP. Thirty-four patients with SAP who exhibited AIGH after debridement and drainage of infected necrosis were analyzed retrospectively. Clinical presentations, vessels and accompaniments involved in bleeding, and the diagnostic methods, as well as the therapeutic approaches and outcomes were reviewed. All patients exhibited AIGH 47 times. Fresh blood flowing out from abdominal drains and bloody stools were the predominant [44.9%] symptoms for AIGH. Ten patients that bled several times underwent early surgeries, and 5 of them repeatedly underwent surgeries. Splenic artery was the vessel most commonly involved in bleeding [46.8%]. Seventeen patients bled in one site 23 times, accompanied by gastrointestinal or choledochal fistula. Seventeen patients bled in multiple sites 24 times. AIGH cases were diagnosed successfully by contrast-enhanced computed tomography [51.7%] and arteriography [46.8%]. Transcatheter arterial embolization [TAE] with "one point" was performed 7 times with 5 [71.4%] recurrent bleedings, whereas TAE with "two points" was performed 12 with only 1 [8.3%] re-bleeding. Early surgical intervention and repeated surgery are two risk factors of AIGH. This condition is related to either one-site bleeding accompanied by a gastrointestinal or choledochal fistula or multi-site bleeding. The diagnostic methods and treatments should be selected based on venous or arterial bleeding. A disciplined three-vessel mesenteric arteriogram should be obtained, and TAE with "two points" embolization is recommended to stop arterial bleeding

Inflammatory colonic obstruction developed as a complication of acute gangrenous cholecystitis

Inflammatory colonic obstruction has rarely been reported as a complication of acute gangrenous cholecystitis. In this paper, we report a male presenting with inflammatory colonic obstruction, secondary to acute gangrenous cholecystitis. He was successfully treated with a laparotomy, adhesiolysis and cholecystotomy and went on to make a good recovery. The case highlights the importance of having a high index of suspicion for acute gangrenous cholecystitis accompanied by inflammatory colonic obstruction when reviewing patients presenting with cholecystolithiasis and colonic obstruction in the presence of raised inflammatory markers, as well as having an early surgery