Isolated pancreatic heamorrhage in association with anticoagulation

Abstract

Haemorrhage is the primary complication of anticoagulation therapy with the gastrointestinal, urinary and nasal tracts the most common sites of bleeding. Haematoma within solid organs is uncommon especially in the absence of blunt trauma. We describe two patients on long term Warfarin therapy who developed focal haematomas within the pancreas. To the best of our knowledge these are the first isolated unprovoked focal pancreatic hematoma cases reported in the literature. The non-specific clinical symptoms and confusing radiological features mimicked pancreatic malignancy and this led to misdiagnosis in the one patient who underwent unnecessary surgical exploration. The haematoma was correctly identified in the second patient who was managed conservatively and had an uneventful recovery.

Transcatheter embolization of anticoagulation related pancreatic pseudocyst hemorrhage: A case report

“…Chiu et al discussed 2 patients who presented with the appearance of masses within the pancreas that were small, contained, and mistaken for malignancy. In their series, hemorrhage stopped upon reversal of the anticoagulation alone [2]. Rigaux et al also described a patient who was on anticoagulation who presented with severe abdominal pain and developed a large intra- and extraperitoneal hemorrhage on imaging.…”

“…In the setting of anticoagulation-related hemorrhage into a pseudocyst without pancreatitis, no cases described in the literature underwent surgical intervention [2], [3], [4]. Given that there is no significant underlying pancreatic inflammation causing the hemorrhage, partial pancreatectomy or necrosectomy is not necessary.…”

“…Given that there is no significant underlying pancreatic inflammation causing the hemorrhage, partial pancreatectomy or necrosectomy is not necessary. In patients who were hemodynamically stable, reversal of the anticoagulation alone was sufficient to stop the hemorrhage [2], [3]. Chiu et al discussed 2 patients who presented with the appearance of masses within the pancreas that were small, contained, and mistaken for malignancy.…”

“…Pancreatic pseudocyst rupture with associated intraabdominal hemorrhage is an even rarer subset of these bleeds. Only 4 other cases of spontaneous pancreatic hemorrhage associated with anticoagulation were found in the literature [2], [3], [4]. None of these were treated with endovascular embolization.…”