Pancreatitis: Preventing catastrophic haemorrhage

World J Gastroenterol. 2017 Aug 14;23(30):5460-5468. doi: 10.3748/wjg.v23.i30.5460.

Abstract

Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.

Keywords: Complication of pancreatitis; Haemorrhage; Pancreatitis; Pseudoaneurysm; Splenicartery.

Publication types

  • Review

MeSH terms

  • Aneurysm, False / diagnostic imaging
  • Aneurysm, False / etiology
  • Aneurysm, False / therapy*
  • Angiography / methods
  • Contrast Media / administration & dosage
  • Embolization, Therapeutic / methods
  • Endoscopy, Gastrointestinal
  • Hemorrhage / diagnostic imaging
  • Hemorrhage / etiology
  • Hemorrhage / therapy*
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Magnetic Resonance Imaging
  • Necrosis
  • Pancreas / blood supply
  • Pancreas / pathology*
  • Pancreatectomy / adverse effects
  • Pancreatectomy / methods
  • Pancreatitis, Acute Necrotizing / complications*
  • Pancreatitis, Acute Necrotizing / epidemiology
  • Pancreatitis, Acute Necrotizing / pathology
  • Pancreatitis, Chronic / complications*
  • Pancreatitis, Chronic / diagnostic imaging
  • Pancreatitis, Chronic / epidemiology
  • Pancreatitis, Chronic / pathology
  • Time Factors
  • Tomography, X-Ray Computed / methods
  • United Kingdom / epidemiology

Substances

  • Contrast Media