Splenic arterial hemorrhage in pancreatitis: Report of three cases

Singh, Gurpreet; Lobo, Dileep N.; Jindal, Anurag; Marwaha, Ram Kumar; Khanna, S. K.

doi:10.1007/bf01636785

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…Surgical treatment is indicated in uncontrolled hemorrhaging, persistent shock, and when embolization is not feasible. 20 A blind laparotomy without a definitive diagnosis is contraindicated, since it is considered to be too dangerous and it may also lead to unnecessary resections. The surgical treatment depends upon the cause of bleeding and the existing underlying pancreatic disease process.…”

Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm of the Superior Pancreaticoduodenal Artery, a Rare Cause of Hemosuccus Pancreaticus: Report of a Case

et al. 2004

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Chronic pancreatitis with a pseudoaneurysm is an established cause of hemosuccus pancreaticus. We herein describe a patient with chronic alcoholic pancreatitis associated with hemosuccus pancreaticus due to a pseudoaneurysm of the anterior superior pancreaticoduodenal artery rupturing in a pseudocyst of pancreas in the head region. Angiographic embolization was unsuccessful and therefore a laparotomy, ligation, and excision of the pseudoaneurysm with external drainage of pseudocyst were performed. Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding. Contrast-enhanced computed tomography and angiography is diagnostic in the majority of the cases. Surgery is the treatment of choice. Selective angiographic embolization may be helpful in tiding over the emergency until surgery can be performed.

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Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm of the Superior Pancreaticoduodenal Artery, a Rare Cause of Hemosuccus Pancreaticus: Report of a Case

et al. 2004

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“…Once the haemodynamic situation is under control, interventional radiographic methods are used for initial treatment, with immediate good results in 60–100% of cases (72.5% in our series) [9, 15, 21]. Angiographic intervention of a haemorrhage from pseudoaneurysm in HP can be carried out either to stabilize the patient in order to perform elective surgery or as a definitive treatment [22, 23, 25]. Failure of catheter embolization may result from factors such as inability to isolate the bleeding vessel, spasm of the bleeding vessel, incomplete arterial occlusion, or misidentification of the bleeding vessel [21, 25, 26].…”

Section: Discussionmentioning

confidence: 99%

“…Angiographic intervention of a haemorrhage from pseudoaneurysm in HP can be carried out either to stabilize the patient in order to perform elective surgery or as a definitive treatment [22, 23, 25]. Failure of catheter embolization may result from factors such as inability to isolate the bleeding vessel, spasm of the bleeding vessel, incomplete arterial occlusion, or misidentification of the bleeding vessel [21, 25, 26]. If a conservative transarterial approach is selected in a patient with chronic pancreatitis, the remaining diseased pancreas adjacent to the previously injured artery may be the source of reoccurrence of arterial injury and bleeding.…”

Section: Discussionmentioning

confidence: 99%

Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre

et al. 2013

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Background. Hemosuccus pancreaticus (HP) is a very rare and obscure cause of upper gastrointestinal bleeding. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Methods. We retrospectively reviewed the records of all patients who presented with HP over the last 15 years at our institution between January 1997 and December 2011. Results. There were a total of 51 patients with a mean age of 32 years. Nineteen patients had chronic alcoholic pancreatitis; twenty-six, five, and one patient had tropical pancreatitis, acute pancreatitis, and idiopathic pancreatitis, respectively. Six patients were managed conservatively. Selective arterial embolization was attempted in 40 of 45 (89%) patients and was successful in 29 of the 40 (72.5%). 16 of 51 (31.4%) patients required surgery. Overall mortality was 7.8%. Length of followup ranged from 6 months to 15 years. Conclusions. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition.

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“…Our patient had no history of hypertension, abdominal trauma, pancreatitis, or portal hypertension that could explain the etiology of her aneurysms. [1][2][3][4] However, angiography revealed various visceral artery dilatations, which strongly suggested an anomaly of the connective tissue. This was confirmed by the postoperative histopathologic findings of a macroscopically normal vessel with various microscopic abnormalities.…”

Section: Discussionmentioning

confidence: 95%

“…[1][2][3][4][5][6] The usual surgical procedure consists of excision of the aneurysm, with or without splenectomy, or of proximal and distal ligation of the aneurysm without excision. Although embolization has become the preferred method of treatment in the last decade, we did not adopt it in our patient because the celiac artery might have been injured.…”

Section: Discussionmentioning

confidence: 99%

Removal of a Splenic Artery with a Large Aneurysm Adhered to the Pancreas Without Pancreatectomy: Report of a Case

et al. 2002

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Splenic artery aneurysms account for about 60% of all visceral aneurysms. The treatment include surgical procedures that sometimes require pancreatectomy. This report describes the case of a 64-year-old woman who had multiple splenic artery aneurysms with various visceral artery dilatations. Because there was no obvious cause for the splenic artery aneurysms and other arterial abnormalities, we suspected an anomaly of the connective tissue, which was subsequently confirmed by a postoperative histopathologic examination. Thus, we decided to remove the whole splenic artery, to eliminate the formation of any further aneurysms, as well as a splenectomy. During the operation, the largest splenic artery aneurysm was found to be adhered to the pancreas too tightly to ablate. It initially appeared that pancreatectomy would be necessary, but considering the associated risk of postoperative complications, we tried to avoid this. Thus, we cut open the aneurysm and excised it, leaving the anterior wall which was adhered to the pancreas. Our procedure proved the best way to preserve the pancreas and eliminate further aneurysmal formation.

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Splenic arterial hemorrhage in pancreatitis: Report of three cases

Cited by 7 publications

References 5 publications

Pseudoaneurysm of the Superior Pancreaticoduodenal Artery, a Rare Cause of Hemosuccus Pancreaticus: Report of a Case

Pseudoaneurysm of the Superior Pancreaticoduodenal Artery, a Rare Cause of Hemosuccus Pancreaticus: Report of a Case

Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre

Removal of a Splenic Artery with a Large Aneurysm Adhered to the Pancreas Without Pancreatectomy: Report of a Case

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