Endovascular Treatment of Arterial Bleeding in Patients with Pancreatitis

Mansueto, Giancarlo; Cenzi, Daniela; D’Onofrio, Mirko; Salvia, Roberto; Gottin, Leonardo; Gumbs, Andrew A.; Mucelli, Roberto Pozzi

doi:10.1159/000107396

Cited by 20 publications

(8 citation statements)

References 30 publications

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“…Postembolisation syndrome and infarction can occur in up to 30% of splenic artery pseudoaneurysm or aneurysm exclusions, 33 although clinically significant infarction of the spleen, or other organs, is rare. Other complications of endovascular coiling include catheterisation failure, 34 arterial dissection occasionally requiring angioplasty to prevent propagation and maintain vessel patency 35 and initiation of acute episodes of pancreatitis. …”

Section: Coil Migration -A Rare Complication Of Endovascular Exclusiomentioning

confidence: 99%

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

Skipworth

Morkane

Raptis

et al. 2011

annals

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INTRODUCTIONWe describe a case of metallic, angiographic coil migration, following radiological exclusion of a gastroduodenal artery pseudoaneurysm secondary to chronic pancreatitis. PATIENTS AND METHODS A 55-year-old man presented to the out-patient clinic with chronic, intermittent, post-prandial, abdominal pain, associated with nausea, vomiting and weight loss. He was known to have chronic pancreatitis and liver disease secondary to alcohol abuse and previously underwent angiographic exclusion of a gastroduodenal artery pseudoaneurysm. During subsequent radiological and endoscopic investigation, an endovascular coil was discovered in the gastric pylorus, associated with ulceration and cavitation. This patient was managed conservatively and enterally fed via naso-jejunal catheter endoscopically placed past the site of the migrated coil. This patient is currently awaiting biliary bypass surgery for chronic pancreatitis, and definitive coil removal will occur concurrently. CONCLUSIONS Literature review reveals that this report is only the eighth to describe coil migration following embolisation of a visceral artery pseudoaneurysm or aneurysm. Endovascular embolisation of pseudoaneurysms and aneurysms is generally safe and effective. More common complications of visceral artery embolisation include rebleeding, pseudoaneurysm reformation and pancreatitis.

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Section: Coil Migration -A Rare Complication Of Endovascular Exclusiomentioning

confidence: 99%

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

Skipworth

Morkane

Raptis

et al. 2011

annals

View full text Add to dashboard Cite

show abstract

“…With the advancement in imaging technology and the growth in the number of patients with immune insufficiency, trauma, and tumor, the incidence of splenic abscess has gradually increased in recent years [9–11]. In addition, vascular disease, intravascular operation, surgical complications, and severe pancreatitis are also important causes of splenic abscess [2, 12–14]. Even so, intravascular embolization is still the first choice for pancreatitis-related splenic arterial disease [15].…”

Section: Discussionmentioning

confidence: 99%

“…Splenic arterial hemorrhage is one of the most serious and potentially lethal complications of severe acute pancreatitis (SAP), and the incidence of it is reported to be as high as 14.5% [1]. Angiographic and vascular embolization has been proven to be a safe and effective treatment option for these patients [2–4]. However, when splenic arterial hemorrhage is controlled, particularly with splenic arterial embolization, the probability of splenic infarction and/or splenic abscess formation increases significantly.…”

Section: Introductionmentioning

confidence: 99%

Management of Splenic Abscess after Splenic Arterial Embolization in Severe Acute Pancreatitis: A 5-Year Single-Center Experience

Chen

Gao

Zhou

et al. 2019

Gastroenterology Research and Practice

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Objective. To describe the management and prognosis of splenic abscess after splenic arterial embolization in severe acute pancreatitis (SAP) patients. Methods. This is a retrospective observational study. From August 2012 to August 2017, SAP patients with infected pancreatic necrosis (IPN) who underwent splenic arterial embolization after massive hemorrhage of the splenic artery were screened and those who developed splenic abscess were included for analysis. The demographic characteristics, etiology, treatment of splenic abscess, and clinical outcomes of these cases were collected and analyzed. Results. A total of 18 patients with splenic abscess formed after splenic arterial embolization were included for data analysis. The median age of the 18 patients was 46 years. The etiologies included biliary AP, hypertriglyceridemic AP (HTG-AP), and other causes. Ten patients underwent minimally invasive percutaneous drainage only for splenic abscess while the other eight patients received splenectomy. One patient died due to uncontrolled infection and another patient died due to massive bleeding, and the remaining sixteen patients survived. Conclusion. The incidence of splenic abscess was high in patients requiring splenic arterial embolization due to massive bleeding. Our data showed that most splenic abscess could be successfully managed with minimally invasive interventions, and traditional splenectomy should serve as a backup treatment.

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“…The progressive enlargement of the pseudocyst induces necrotizing vessels because of the added pressure on the vessel walls and from the action of proteolytic enzymes. This leads to the erosion of the vessel walls, resulting in intracystic hemorrhage [4]. Another important cause of intracystic hemorrhage is the rupture of the pseudoaneurysm, which often results in massive bleeding to cause shock status and is usually treated by emergency transarterial embolization (TAE) or operation [5].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic pseudocyst with pancreatolithiasis and intracystic hemorrhage treated with distal pancreatectomy: a case report

Maeda

Nomura

Moriki

et al. 2009

Cases J

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IntroductionHemorrhage from pancreatic pseudocyst is one of the serious complications of chronic pancreatitis. We experienced intracystic hemorrhage from a huge pancreatic pseudocyst and successfully treated it with distal pancreatectomy.Case presentationA 65-year-old-man with a history of alcohol abuse was admitted to our hospital for abdominal pain and was diagnosed as having chronic pancreatitis with pancreatolithiasis and pseudocyst in the pancreatic tail. The pancreatic pseudocyst increased in size gradually for 4 month observation period. For intracystic hemorrhage we performed an urgent distal pancreatectomy with splenectomy. Postoperative course was good and the elevated serum amylase level decreased to the normal range.ConclusionProlonged observation resulted in intracystic hemorrhage. Drainage or surgery in adequate time is important for the management of pancreatic pseudocysts to prevent complications.

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Endovascular Treatment of Arterial Bleeding in Patients with Pancreatitis

Cited by 20 publications

References 30 publications

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

Management of Splenic Abscess after Splenic Arterial Embolization in Severe Acute Pancreatitis: A 5-Year Single-Center Experience

Pancreatic pseudocyst with pancreatolithiasis and intracystic hemorrhage treated with distal pancreatectomy: a case report

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