Original communicationManagement and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis
Section snippets
Patients and methods
Over a period of 10.5 years, 35 patients (28 male, 7 female) with pancreatitis and arterial pseudoaneurysms were admitted to our surgical department. Data from these patients regarding bleeding complications caused by pseudoaneurysms were reviewed from our prospective pancreas database. The average age of all patients with pseudoaneurysms was 51 years (range, 28-75). Alcohol abuse was the main cause of pancreatitis (86%), and 5 patients had biliary pancreatitis. There was no significant
Presentation
The most common symptoms for all 35 patients with pseudoaneurysms were pain and gastrointestinal hemorrhage, which occurred in 16 patients (4 with hemosuccus pancreaticus, 3 with hemobilia). Seventeen patients (49%) presented with an acute onset of severe abdominal pain. Fifteen (43%) presented with massive hemorrhage as evidenced by rapidly worsening anemia and hemorrhagic shock.
The most common arteries involved were the splenic, intrapancreatic, and gastroduodenal arteries. The involved
Discussion
Gastrointestinal bleeding complications in patients with either acute or chronic pancreatitis usually are attributed to peptic ulcers, erosive gastritis, or esophageal and gastric fundus varices. Nevertheless, pseudoaneurysmal bleeding is a serious, though rare, complication of pancreatitis. For this reason, it is unlikely that randomized trials will be forthcoming to provide evidence for the relative merits of operative or radiologic intervention. Therefore, the caregiver must rely on the data
References (23)
- et al.
Evidence for a central role for selective mesenteric angiography in the management of the major vascular complications of pancreatitis
Am J Surg
(2003) - et al.
Arterial complications of pancreatitis:diagnostic and therapeutic aspects in 104 cases
J Vasc Interv Radiol
(1993) - et al.
Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, 28-30 March 1984
Gastroenterology
(1985) Vascular complications of pancreatitis
Radiol Clin North Am
(1989)- et al.
Gastroduodenal and pancreatico-duodenal artery aneurysms: a complication of pancreatitis causing spontaneous gastrointestinal hemorrhage
Surgery
(1980) - et al.
Pseudocysts in chronic pancreatitis. Surgical results in 102 consecutive patients
Arch Surg
(1989) - et al.
Hemorrhagic complications of severe pancreatitis
Surgery
(1981) - et al.
Aneurysms secondary to pancreatitis
AJR
(1976) - et al.
Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis
Br J Surg
(1991) - et al.
Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis
Arch Surg
(1997)
Pancreatic pseudocysts in chronic pancreatitis. Differential diagnosis and therapy
Chirurg
Cited by (158)
Visceral artery pseudoaneurysms in necrotizing pancreatitis: risk of early bleeding with lumen-apposing metal stents
2022, Gastrointestinal EndoscopyPost-embolization outcomes of splenic artery pseudoaneurysms: A single-center experience
2021, Clinical ImagingImmediate and Long-Term Outcomes of Percutaneous Radiological Interventions for Hemorrhagic Complications in Acute and Chronic Pancreatitis
2021, Journal of Vascular and Interventional RadiologySplenic Artery Pseudoaneurysm in Chronic Pancreatitis Causing Obstructive Jaundice: Endovascular Management
2021, Annals of Vascular SurgeryManagement of acute pancreatitis. A literature review
2021, Revue de Medecine InterneEndovascular and percutaneous transabdominal embolisation of pseudoaneurysms in pancreatitis: an experience from a tertiary-care referral centre
2021, Clinical RadiologyCitation Excerpt :Vascular complications occur with variable frequency in pancreatitis depending on the severity, presence of pancreatic necrosis, and the extent of extra-pancreatic involvement.1