Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis

Abstract

Spontaneous haemorrhage associated with chronic pancreatitis in 17 patients was related to a pseudocyst in 15 (88 per cent) patients and to pancreatic lithiasis (one patient) or to infarction-rupture of the spleen (one patient). Bleeding was massive in six patients and intermittent in 11. It resulted from erosion of the gastroduodenal or the splenic artery in four patients. Bleeding into the pancreatic duct occurred in four patients and erosion of the duodenum by a bleeding pseudocyst in five. Haemorrhage was confined to a pseudocyst in six patients and was intraperitoneal in two. Of the 15 patients with bleeding pseudocysts, ten underwent primary pancreatic resection (eight proximal and two distal pancreatectomies) with no mortality but four had early complications. Four of the five patients who underwent transcystic ligation of bleeding vessels and pseudocyst drainage had postoperative complications: one died from sepsis and liver failure and three underwent reoperation for severe postoperative bleeding. Of these, two had proximal pancreatic resection with one death. The third patient had further suture ligation and external drainage. The overall postoperative mortality rate was 12 per cent and following emergency surgery 33 per cent. Favourable results were achieved in two-thirds of patients when the primary operative strategy could be directed towards the control of bleeding and removal of the affected pancreatic segment. Primary pancreatic resection, although technically demanding in the presence of haemorrhage, is recommended whenever possible for the treatment of bleeding pancreatic pseudocysts and pseudoaneurysms associated with chronic pancreatitis.

Haemosuccus Pancreaticus in Chronic Pancreatitis — Diagnosis and Treatment

“…These aneurysms are frequent in about 10 % in chronic pancreatitis. Vascular ulceration by pancreatic intraductal stone is also thought to be a cause of hemosuccus pancreaticus [10,18]. Although aneurysm and chronic pancreatitis are often associated, there is no clear causal relationship.…”

Spätkomplikationen nach Pankreaseingriffen

“…Abb. 1) [10]. Bei Anschluss an den Pankreasgang kann sich dies als hartnäckige, aber teils schwer nachweisbare obere gastrointestinale (GI-)Blutung äußern ("Hemosuccus pancreaticus"; [25]).…”

Endovascular Treatment of Arterial Bleeding in Patients with Pancreatitis

“…Emergency surgery for arterial disruption has a high failure rate, with a greater than 80% risk of recurrent bleeding [23][24][25][26][27] and a mortality rate greater than 50% [8] . In our experience, the overall survival rate with radiologic treatment is 81%.…”