hemorrhagic pancreatitis: be afraid

3 Jun

it is rare, scary, and deadly.  

 

 

Ann Ital Chir. 1995 Mar-Apr;66(2):233-7. Severe hemorrhagic complications in pancreatitis. Flati G,

 

Why does it happen?

Pseudocysts, severe inflammation, regional necrosis and infection may cause major vessel erosion with or without pseudoaneurysm formation which eventually may result in severe bleeding into the gastrointestinal tract, retroperitoneum and peritoneal cavity.

 

Mortality:

  • chronic pancreatitis: 22%
  • acute pancreatitis: 60.4%
  • acute on chronic: 57.1

 

most commonly involved vessels:

  • Splenic (mortality 20.5%)
  • gastroduodenal (mortality 27.9%)
  • superior pancreaticoduodenal (mortality 46.1%)

Pancreatology. 2001;1(4):306-13. Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging. Balthazar EJ, Fisher LA.

RARE:

26/1910 patients diagnosed of having pancreatitis developed hemorrhagic complications (1.3%)

  • 10 had CT evidence of pancreatic necrosis,
  • 12 patients chronic pancreatitis,
  • 17 patients pancreatic pseudocysts.

cause of hemorrhage:

  • bleeding pseudoaneurysm in 16 patients (61%),
  • diffuse bleeding with pancreatic necrosis in 5 patients (19.5%)
  • hemorrhagic pseudocysts in 5 patients (19.5%).

Where?

  • Intra-abdominal hemorrhage in 21 patients
  • gastro-intestinal bleeding in 5 patients.

Treatment options?

  • Arterial embolization was attempted in 12 patients and successful in 9 patients (75%).
  • Surgery was used in 16 patients and the overall mortality rate was 11%.

 

References: article 1; article 2; picture

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