Strategy and management of severe hemorrhage complicating pancreatitis and post-pancreatectomy

Özet

PURPOSE Transcatheter arterial embolization (TAE) is increasingly used as the first-line treatment for hem-orrhage complicating pancreatitis and post-pancreatectomy. However, the optimal therapeutic strategy remains unclear.METHODSAmong 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.RESULTSPancreatic 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. Suc-cessful 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.CONCLUSIONEndovascular management is effective for achieving hemostasis in severe pancreatic hemor-rhage with a high success rate and low recurrence, and laparotomy is not suitable for rebleeding cases.