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 2019; 25: 81-89
DOI: 10.5152/dir.2018.18283
Abstract

PURPOSE: 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: Among 1924 consecutive patients, 40 patients with severe pancreatic hemorrhage in Xuanwu Hospital were enrolled between 2005 and 2017. Patients underwent angiography and direct TAE for primary diagnosis and treatment of bleeding. Repeat TAE, watch and wait, and laparotomy were used as the other therapeutic options. Patient data, technical 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%). A history of percutaneous catheter drainage or pancreatic surgery was seen in 29 patients (72.5%). There were 48 angiographies, 31 embolizations, and 5 laparotomies performed. Rebleeding occurred in 8 patients (20%); 4 of whom underwent re-embolization, 3 had laparotomy, and 1 had conservative treatment. 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 alive at the 90-day follow-up.

 

CONCLUSION: Endovascular management is effective for achieving hemostasis in severe pancreatic hemorrhage with a high success rate and low recurrence, and laparotomy is not suitable for rebleeding cases.

 

You may cite this article as: Zhang C, Li A, Luo T, et al. Strategy and management of severe hemorrhage complicating pancreatitis and post-pancreatectomy. Diagn Interv Radiol 2019; 25: 81–89.

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