ABSTRACT
Massive hemorrhage associated with pancreatitis is a rare but frequently lethal complication. Fifteen patients with this complication are presented. Bleeding occurred in four patients with necrotizing pancreatitis, in three patients with pancreatic abscesses, in seven patients with pseudocysts, and in one patient with chronic relapsing pancreatitis following longitudinal pancreaticojejunostomy. The initial presentation of hemorrhage was gastrointestinal in eight patients and retroperitoneal or intraperitoneal in seven. Abdominal pain with associated nausea and vomiting was present in all patients on admission. Duration of symptoms prior to hospitalization averaged 6 days. During hospitalization the 15 patients received a total of 512 units of blood for transfusions ranging from 8 to 177 units. Admission amylase values were of no benefit in assessing severity of the disease, but application of Ranson's criteria accurately predicted both severity and prognosis. The common denominator in all cases of bleeding appeared to be the presence of an overwhelming or continuing inflammatory process with necrosis and erosion of adjacent vascular and visceral structures. The overall mortality rate in the series was 53.3%. Those patients with hemorrhage associated with pseudocyst formation had the highest survival rates, whereas those with necrotizing pancreatitis and hemorrhage had an extremely poor response to aggressive medical and/or surgical management.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Hemoperitoneum/etiology , Pancreatitis/complications , Abscess/complications , Adolescent , Adult , Blood Transfusion , Female , Gastrointestinal Hemorrhage/mortality , Hemoperitoneum/mortality , Humans , Male , Middle Aged , Necrosis , Pancreatic Diseases/complications , Pancreatic Pseudocyst/complications , Postoperative Complications , Retroperitoneal SpaceABSTRACT
Selective arterial embolization is an established technique to control gastrointestinal bleeding in patients who are poor surgical risks and in whom bleeding is uncontrolled by other methods. This article describes the control of upper gastrointestinal bleeding by subselective embolization of a bleeding branch of the dorsal pancreatic artery in a patient with severe pancreatitis. This is the first recorded successful embolization of the dorsal pancreatic artery to control hemorrhage.