E-ISSN 1305-3612
Interventional Radiology - Original Article
Strategy and management of severe hemorrhage complicating pancreatitis and post-pancreatectomy
Ang Li 1 ,  
Tao Luo 2 ,  
Jia Li 1 ,  
Feng Cao 1 ,  
Fei Li 1  
1 Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China  
2 Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China  
Diagn Interv Radiol ; : -

Abstract

Propose: Transcatheter arterial embolization (TAE) is increasingly used as the first-line treatment for hemorrhage complicating pancreatitis and post-pancreatectomy. However, the optimal therapeutic strategy remains unclear.


Methods
: Forty patients with severe pancreatic hemorrhage in **** Hospital among 1924 consecutive patients were enrolled between 2005 and 2017. Patients underwent angiography and direct TAE as the primary diagnosis and treatment for the bleeding. Re-TAE, watch and wait, and laparotomy were used as the other therapeutic options. Patient data, technique success and 90-day survival were identified.


Results
: Pancreatic diseases underlying hemorrhage included acute pancreatitis (n=19; 47.5%), chronic pancreatitis (n=12; 30%), and pancreatic cancer (n=9; 22.5%). Twenty-nine patients (72.5%) had a history of percutaneous catheter drainage or pancreatic surgery. There were 48 angiographies, 31 embolizations and 5 laparotomies performed. Re-bleeding occurred in 8 patients (20%), of whom 4 underwent re-embolization, 3 laparotomy and 1 conservation. Successful clinical hemostasis was achieved in 37 patients. Complications were observed in only 2 patients with renal failure and 1 patient with hepatic insufficiency. In total, 25 patients (62.5%) were lived at the 90-day follow-up.


Conclusion
: Endovascular management is effective for achieving hemostasis for severe pancreatic hemorrhage with a high success rate and low recurrence, and laparotomy is not suitable for the re-bleeding case. 

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