Acute necrotising pancreatitis: a late and fatal complication of pancreaticoduodenal arterial embolisation

Abstract

SUMMARYA 70-year-old man was diagnosed with a massive bleeding duodenal ulcer which was refractory to emergency endoscopic management. Angiogram of the coeliac and superior mesenteric arteries revealed bleeding from the superior and inferior pancreaticoduodenal arteries. Transcatheter arterial embolisation of superior and inferior pancreaticoduodenal arteries along with the gastroduodenal artery was performed. Two weeks later he developed severe necrotising pancreatitis of the pancreatic head probably due to ischaemia, which was managed conservatively. Three months later the patient experienced another episode of pancreatitis which progressed into multiorgan dysfunction and the patient passed away. BACKGROUND

Acute ischemic pancreatitis: A rare complication of empirical gastroduodenal artery embolization

“…The body and tail of the pancreas are supplied by the dorsal pancreatic and caudal pancreatic arteries, both of which are branches of the splenic artery. [ 11 ]…”

“…A literature search yielded four cases of acute pancreatitis reported after TAE for refractory UGIB. [ 11 12 13 14 ] Coils ± gelfoam were used as the embolic agents in all four cases with embolization of “front and back door” supply as per conventional principles. The patients presented with symptoms of pancreatitis of 12 hours to 70 days duration (mean = 29 days) post GDA embolization.…”

Recurrent Walled-Off Necrosis Following Embolization with N-Butyl-2-Cyanoacrylate in a Patient with Upper Gastrointestinal Tract Bleeding

“…Wang et al [13] reported a case series of 29 patients managed with TAE with a 93% success rate and no ischemic complications. There has only been one case report of necrotizing pancreatitis following TAE of the superior and inferior pancreaticoduodenal arteries with metal coils and gelatin sponges for a bleeding duodenal ulcer [14]. Although rare, pancreatitis is known to be a complication after TAE of the branch of the pancreaticoduodenal artery [14].…”

“…There has only been one case report of necrotizing pancreatitis following TAE of the superior and inferior pancreaticoduodenal arteries with metal coils and gelatin sponges for a bleeding duodenal ulcer [14]. Although rare, pancreatitis is known to be a complication after TAE of the branch of the pancreaticoduodenal artery [14]. Pancreatitis following transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma also carries a significant risk of morbidity and mortality [15].…”

Integrated traditional Chinese medicine improves acute pancreatitis via the downregulation of PRSS1 and SPINK1

“…Acute pancreatitis (AP) is a common disease of the digestive system, characterized by acute, severe symptoms, a variety of complications and a high rate of mortality ( 1 , 2 ). Paralytic intestinal obstruction is an early clinical symptom of AP, occurring in >80% of cases ( 3 ).…”