Treatment of Bleeding Pseudoaneurysms in Patients with Chronic Pancreatitis

Udd, Marianne; Leppäniemi, Ari K.; Bidel, Siamak; Keto, Pekka; Roth, Wolf-Dieter; Haapiainen, Reijo K.
March 2007
World Journal of Surgery;Mar2007, Vol. 31 Issue 3, p504
Academic Journal
In patients with chronic pancreatitis, an actively bleeding pseudoaneurysm can be life-threatening. Angioembolization is an attractive alternative to often complex operative management, and its feasibility was assessed in a retrospective analysis. During 1993–2005, 33 patients (27 males, median age 51 years) with bleeding pancreatic pseudoaneurysms underwent urgent angiographic evaluation followed by angioembolization if possible. Angioembolization was performed in 23 patients, whereas 10 patients required hemostatic surgery, including 6 distal pancreatectomies and 3 vessel ligations. Between 1993 and 2005 33 out of 745 patients (4.4%) admitted for chronic pancreatitis had bleeding pancreatic pseudoaneurysms. The proportion of bleeders out of the total number of hospital admissions for chronic pancreatitis was 33 out of 1,892 (1.7%). The overall success rate of angioembolization was 22 out of 33 (67%) including 3 patients requiring re-embolization for recurrent bleeding. The success rate was 16 out of 20 (80%) when the pseudocyst was in the head of the pancreas, and only 50% when the splenic artery was the source of bleeding. Four of the 5 cases with free bleeding into the peritoneal cavity required operative intervention. The overall mortality and morbidity rates were 2 out of 33 (6%) and 7 out of 33 (21%) respectively, with no significant differences between embolized and operated patients. Angioembolization was associated with a significantly lower need for total blood transfusions and length of hospital stay. During the years 2000–2005, the overall success rate of angioembolization was 95%. All hemodynamically stable patients with chronic pancreatitis and bleeding pseudoaneurysms should undergo prompt initial angiographic evaluation and embolization if possible. Repeated angioembolization is feasible in patients with recurrent bleeding, whether initially embolized or operated. Patients with unsuccessful embolization should undergo emergency hemostatic surgery with ligation of the bleeding vessel in the head of the pancreas and distal resection in patients bleeding from the splenic artery or its branch. The combination of angioembolization and later endoscopic drainage of the pseudocyst via endoscopic retrograde cholangiopancreatography (ERCP) is effective in the majority of the cases of pseudoaneurysms in chronic pancreatitis.


Related Articles

  • Hemorrhage into pancreatic pseudocyst. Ikeda, Osamu; Kume, Shuichi; Torigoe, Yoshitsugu; Iryou, Yasuhiko; Tamura, Yoshitaka; Kawanaka, Kouichi; Yamashita, Yasuyuki // Abdominal Imaging;May2007, Vol. 32 Issue 3, p370 

    We report a patient whose upper abdominal pain was due to an alcoholic pancreatic pseudocyst with hemorrhage. CT showed a gradually enhancing pancreatic pseudocyst about 6 cm in diameter. It exhibited hyposignal intensity on T2-weighted images and hypersignal intensity on T1-weighted images....

  • Covered Stents Used for Late, Postpancreatectomy Hemorrhage in the Common Hepatic Artery.  // American Surgeon;Feb2011, Vol. 77 Issue 2, p236 

    The article describes the clinical case of a 76-year-old male patient who was diagnosed with postpancreatectomy hemorrhage (PPH). The patient was referred for operative treatment of suspected pancreatic head cancer. He underwent residual pancreatectomy and splenectomy for grade C pancreatic...

  • Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database. Darnis, B.; Lebeau, R.; Chopin-Laly, X.; Adham, M. // Langenbeck's Archives of Surgery;Mar2013, Vol. 398 Issue 3, p441 

    Background: Postpancreatectomy hemorrhage (PPH) is a dreaded complication in pancreatic surgery. Today, there is a definition and grading of PPH without therapeutic consensus. We reviewed our prospective database to identify predictors and assess therapeutic strategy. Method: We included all...

  • Transcatheter embolization of a superior mesenteric artery pseudoaneurysm. A case report. Hama, Y.; Kaji, T.; Kawasaki, Y.; Kyoto, Y.; Kawarabayashi, N.; Hatsuse, K.; Kusano, S.; Iwasaki, Y // Acta Radiologica;Nov1999, Vol. 40 Issue 6, p649 

    A 61-year-old man, with pseudoaneurysm of the superior mesenteric artery presenting with gastrointestinal bleeding, was successfully treated by transcatheter embolization using interlocking detachable coils. During the following observation time of 10 months, the patient had no sign of...

  • PSEUDOANEURYSMS OF THE PERIPANCREATIC ARTERIES IN PATIENTS WITH CHRONIC PANCREATITIS. Lech, Gustaw; Bernat, Dominika; Słodkowski, Maciej; Pawłowski, Waldemar; Jankowski, Mieczysław; Słotwiński, Robert; Krasnodębski, Ireneusz Wojciech // Polish Surgery / Chirurgia Polska;2006 Supplement, Vol. 8, p17 

    Pseudoaneurysms of the peripancreatic arteries are rare but very serious complications of chronic pancreatitis. The aim of this study was to investigate the diagnostic and treatment methods used on 6 patients with pseudoaneurysms of the peripancreatic arteries and chronic pancreatitis...

  • A Newly Recognized Entity: Intraductal "Oncocytic" Papillary Neoplasm of the Pancreas. Jyotheeswaran, S.; Zotalis, G.; Penmetsa, P.; Levea, C. M.; Schoeniger, L. O.; Shah, A. N. // American Journal of Gastroenterology;Dec1998, Vol. 93 Issue 12, p2539 

    Intraductal papillary-mucinous tumors of the pancreas are increasingly recognized, and their characteristic endoscopic and radiological features are well reported in the literature in recent years. Oncocytic features in these tumors are uncommon and unrecognized. Intraductal oncocytic papillary...

  • Management of postgastric bypass noninsulinoma pancreatogenous hypoglycemia. Mathavan, Viney K.; Arregui, Maurice; Davis, Chad; Singh, Kirpal; Patel, Anand; Meacham, James // Surgical Endoscopy;Oct2010, Vol. 24 Issue 10, p2547 

    Introduction: Postgastric bypass noninsulinoma hyperinsulinemic pancreatogenous hypoglycemia defines a group of patients with postprandial neuroglycopenic symptoms similar to insulinoma but in many cases more severe. There are few reports of patients with this condition. We describe our surgical...

  • Long-term results after surgery for autoimmune sclerosing pancreatitis. Schnelldorfer, Thomas; Lewin, David N.; Adams, David B. // Journal of Gastrointestinal Surgery;Jan2007, Vol. 11 Issue 1, p56 

    Autoimmune sclerosing pancreatitis (ASP) is a recently recognized cause of chronic pancreatitis. The role of operative intervention in this disease is controversial. A single center experience with 161 consecutive pancreatic resections for chronic pancreatitis was retrospectively reviewed....

  • Pancreatic Pseudocyst Involving the Spleen. Kothari, Tarun; Mangla, Jagdish C.; Gutierrez, Oscar H. // American Journal of Gastroenterology;Aug1979, Vol. 72 Issue 2, p175 

    A case of pseudocyst of the tail of the pancreas involving the spleen is presented. Diagnosis of splenic involvement by pseudocyst was made by angiography followed by immediate (elective) surgical intervention with distal pancreatectomy and splenectomy without pre- or postoperative complications.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics