Non-traumatic abdominal emergencies: imaging and intervention in acute pancreatic conditions

Abstract

Pancreatic emergency, unrelated to traumatic events, can occur as a consequence of the more significant pancreatic pathologies (acute and chronic pancreatitis, tumors) or of the interventional or surgical treatment carried out as therapy for the above-mentioned lesions. Acute pancreatic conditions are represented by pancreatic infections, the involvement of organs, structures, and adjacent spaces within the pancreatic disease, and, lastly, vascular complications. Acute pancreatic conditions are common in pancreatic diseases and can be catastrophic; even if there is a gamut in the severity of clinical presentation, each can be potentially life threatening. Immediate radiological detection of the lesions together with a correct therapeutic percutaneous radiological approach whenever an interventional procedure is preferable to surgery or, when performed before surgery, whenever it can optimize its results, is of fundamental importance in the management of these patients. This article focuses on the essential role of radiology and the integration of imaging and intervention in acute pancreatic conditions.

Endovascular Treatment of Arterial Bleeding in Patients with Pancreatitis

“…As a result, it is possible to occlude the downstream vessel of the arterial lesion with controlled polymerization as well as fill the lesion and then occlude the proximal vessels ( fig. 2 ) [2] . Re-absorbable embolic materials, such as gelatin sponge, should not be utilized because proteolytic enzymes rapidly degrade them.…”

“…The literature reports the presence of pseudoaneurysms in 10-21% of patients with chronic pancreatitis [2,4] . The incidence of bleeding pseudocysts in chronic pancreatitis has been reported to be 6-10% [5] .…”

“…As defined by the 1992 Atlanta International Symposium on Acute Pancreatitis [3] , massive bleeding in severe acute pancreatitis is a consequence of the erosion of peripancreatic arteries (arterial disruption) by the activated proteolytic enzymes [2] . When pancreatitis is associated with a pseudocyst, the progressive enlargement of the pseudocyst induces necrotizing arteritis because of the added pressure on the vessel walls and from the action of proteolytic enzymes.…”

“…Major arterial hemorrhagic complications in pancreatitis are an infrequent but life-threatening condition [1,2] . As defined by the 1992 Atlanta International Symposium on Acute Pancreatitis [3] , massive bleeding in severe acute pancreatitis is a consequence of the erosion of peripancreatic arteries (arterial disruption) by the activated proteolytic enzymes [2] .…”

A successful outcome of treatment in a patient with a spleen artery aneurysm complicated by bleeding in pseudocyst of the pancreas

“…Псевдоаневризма -редкое сосудистое осложнение острого панкреатита, которое формируется в результате эрозии стенки висцеральной артерии с формированием фиброзной капсулы, которая имеет тенденцию к росту из-за постоянного высокого артериального давления [1][2][3]. Впервые аневризма селезеночной артерии была опи-сана M. Beaussier в 1770 г.…”