Control of major haemorrhage associated with pancreatic pseudocysts by transcatheter arterial embolization

Abstract

Massive haemorrhage from a pancreatic pseudocyst is an uncommon cause of upper gastrointestinal bleeding. The condition carries a high mortality and presents a major clinical problem both in terms of timely diagnosis and appropriate surgical therapy. Four patients are presented with pseudocyst-related bleeding arising from the gastroduodenal artery. In all instances the bleeding was successfully controlled by transcatheter embolization with gelfoam. No untoward sequelae were noted and the occlusion remained effective as shown by follow-up angiography 2 months later. The importance of early diagnostic angiography is stressed and it is concluded that interventional angiography may obviate the need for high risk emergency surgery.

Case of hemorrhagic pancreatic pseudocyst in which ultrasound imaging was useful

“…[1][2][3][4][5][6][7][8][9] Currently, bleeding pancreatic pseudocysts are usually treated by TAE using steel coils, which produces more favorable therapeutic results than surgery. 2,4,6,10,18,19 A bleeding pancreatic pseudocyst was diagnosed early in the present case. Because our knowledge of this condition was limited, however, we managed the patient by monitoring alone.The patient eventually suffered hypovolemic shock caused by rupture of the pseudocyst into the duodenum.…”

“…2,3,5,9 Endoscopy helps differentiate upper gastrointestinal tract bleeding from peptic ulcer, gastritis, varices, and Mallory-Weiss syndrome, but the diagnosis is difficult because it is based on endoscopic findings alone. [2][3][4][6][7][8]10 Angiography is the most direct investigation, and its diagnostic value is high. Angiography facilitates the diagnosis of a bleeding pancreatic pseudocyst: It can detect a pseudocyst around a vessel near the pancreas and leakage of contrast medium into the gastrointestinal tract.…”

“…Because it is a dangerous complication, however, its diagnosis is clinically important. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] We describe a case of a pancreatic pseudocyst that ruptured into the duodenum, causing hypovolemic shock. Ultrasound imaging proved useful for treating this case.…”

Hemorrhagic Pancreatic Pseudocysts

“…The technique of choice is then an internal derivation associ ated with a local hemostasis [63]. The techniques of embolization [39] or vascular obstruction by catheter [64] can also be considered in association with the surgi cal procedures.…”

Diagnostic Pitfalls and Therapeutic Strategies in the Treatment of Pancreatic Duct Haemorrhage

“…The splenic artery was the commonest source of bleeding and the gastroduodenal and pancreaticoduodenal.artery or other branches were less frequently involved [7,[15][16][17]. When the head of the pancreas is involved angiographic embolisation may be successful in aneurysrns involving smaller vessels [15][16][17][18] [11].…”