Severe hemorrhagic complications in pancreatitis

Area of Science:

• Gastroenterology
• Vascular Surgery
• Interventional Radiology

Background:

• Severe bleeding is a significant complication of acute and chronic pancreatitis.
• Vessel erosion due to pseudocysts, inflammation, necrosis, or infection can lead to massive hemorrhage.
• Hemorrhage can manifest in the gastrointestinal tract, retroperitoneum, or peritoneal cavity.

Purpose of the Study:

• To analyze the experience of 8 cases and review 389 literature cases of massive bleeding related to pancreatitis.
• To identify factors influencing mortality in pancreatitis-related massive bleeding.
• To evaluate the role of diagnostic and interventional radiology in managing this complication.

Main Methods:

• Retrospective case series analysis.
• Comprehensive literature review of massive bleeding in pancreatitis over 100 years (until December 1993).
• Analysis of bleeding etiology, localization, and underlying pathology.

Main Results:

• Mortality rates vary significantly: 22% for chronic pancreatitis, 60.4% for acute pancreatitis, and 57.1% for chronic pancreatitis with acute exacerbation.
• Commonly involved vessels include splenic (20.5% mortality), gastroduodenal (27.9% mortality), and superior pancreaticoduodenal arteries (46.1% mortality).
• Bleeding from infected necrosis or abscesses has a worse prognosis than from pseudocysts.

Conclusions:

• Mortality is linked to bleeding etiology, location, and pathology.
• Diagnostic and interventional radiology are key to improving survival.
• Early identification, angiographic control, and timely surgical intervention are essential for managing pancreatitis-induced massive hemorrhage.