Hemorrhagic complications of pancreatitis: Radiologic evaluation with emphasis on CT imaging

Practice Guidelines in Acute Pancreatitis

“…Occasionally, the pancreas is well enough seen by abdominal ultrasound to reveal features that are consistent with the diagnosis of acute pancreatitis including diffuse glandular enlargement, hypoechoic texture of the pancreas reflective of edema, and ascites. Contrast-enhanced CT scan (and in particular a contrast-enhanced thin-section multidetector-row CT scan) is the best imaging technique to exclude conditions that masquerade as acute pancreatitis, to diagnose the severity of acute pancreatitis, and to identify complications of pancreatitis (33)(34)(35). Findings on CT scan that confirm the diagnosis of acute pancreatitis include enlargement of the pancreas with diffuse edema, heterogeneity of pancreatic parenchyma, peripancreatic stranding, and peripancreatic fluid collections.…”

“…Complications in acute pancreatitis that can be recognized on abdominal CT scan include pancreatic fluid collections, gastrointestinal and biliary complications (such as obstruction of duodenum or stomach, inflammation of the transverse colon, and biliary obstruction), solid organ involvement (such as splenic infarct), vascular complications (such as pseudoaneurysms, splenic vein thrombosis with varices, portal vein thrombosis), and pancreatic ascites (33,35,90).…”

“…If a pseudoaneurysm is discovered, the treatment of choice is angiographic insertion of a coil to embolize the pseudoaneurysm. Surgery is required if this technique fails (35,198).…”

Hepatic Artery Pseudoaneurysm with Extrahepatic Biliary Obstruction

“…They have been reported as a late complication, occurring an average of 2 to 3 years after the first episode of pancreatitis, after repeated acute bouts in patients with chronic pancreatitis. 4,5) The splenic artery is the most commonly involved vessel, accounting for half of cases of pseudoaneurysms in chronic pancreatitis, particularly because of its anatomic location. 6) The frequency of hepatic artery pseudoaneurysms due to chronic pancreatitis is comparatively uncommon at 2% to 12%.…”

Evaluation of Clinical Success and Outcomes in Management of Peripancreatic Haemorrhage

“…4 At present the best modality of assessing a hemodynamically stable patient with Peripancreatic haemorrhage is CT angiogram. 5 In most of the cases this provides an accurate diagnosis and when combined with conventional angiogram, embolization of the feeding vessel or the pseudo aneurysm itself can be attempted.…”