Endovascular Management of Major Arterial Hemorrhage as a Complication of Inflammatory Pancreatic Disease

Hyare, Harpreet; Desigan, Sharmini; Brookes, Jocelyn; Guiney, Michael; Lees, W. R.

doi:10.1016/j.jvir.2007.02.035

Cited by 39 publications

(46 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some studies have shown that percutaneous angiographic embolisation techniques carry a similar mortality rate to operative strategies, thus reflecting the multisystem involvement of pancreatic disease. 2,3,5 However, other authors have shown that radiological embolisation strategies are associated with a decreased incidence of blood transfusion and length of hospital stay, 2 as well as lower rebleed and mortality rates. 11 Radiographic embolisation, therefore, remains the mainstay of treatment in our centre.…”

Section: Discussionmentioning

confidence: 99%

“…2 Mesenteric angiography successfully localises bleeding foci in > 80% of cases of visceral artery pseudoaneurysm, 2,10,11 and is associated with a low complication rate. 10 Radiological embolisation achieves definitive haemostasis in 80-95% of cases, 2,3,5,10 and is associated with an improved outcome when early recognition and prompt exclusion takes place. 4 However, re-bleeding from known pseudoaneurysms and development of further vascular abnormalities can occur, as in this case, mandating careful clinical follow-up and repeat angiography as necessary.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, re-bleeding from known pseudoaneurysms and development of further vascular abnormalities can occur, as in this case, mandating careful clinical follow-up and repeat angiography as necessary. 5 Splenic artery occlusion can lead to postembolisation syndrome and infarction in up to 30%. 12 However, significant complications of embolisation, such as enterocutaneous fistula seen here, are rare.…”

Section: Discussionmentioning

confidence: 99%

“…3 It can lead to massive haemorrhage into the gastrointestinal tract or peritoneal cavity, and results in death in 20-40% of cases. [3][4][5] Case report…”

mentioning

confidence: 99%

See 3 more Smart Citations

The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

Skipworth

Raptis

Brennand

et al. 2009

annals

View full text Add to dashboard Cite

Ann R Coll Surg Engl 2009; 91: 255-258 255Pancreatitis is a common condition with an increasing incidence, but a mortality rate that has not significantly decreased since the 1970s.1 Bleeding from visceral artery pseudoaneurysms is a rare, but potentially lethal, complication, occurring in less than 2% of cases of chronic pancreatitis, 2 and even less frequently following acute pancreatitis and pancreatic surgery.3 It can lead to massive haemorrhage into the gastrointestinal tract or peritoneal cavity, and results in death in 20-40% of cases. 3-5 Case reportLocal management BM, a 45-year-old man, presented to his local casualty department with severe epigastric pain following significant alcohol consumption. Epigastric tenderness was elicited on abdominal examination and blood results revealed significantly raised serum amylase, white cell count (WCC) and C-reactive protein (CRP) levels, associated with haemoconcentration (raised mean corpuscular volume and haemoglobin [Hb] levels) and decreased serum calcium. He was subsequently diagnosed with acute pancreatitis, and the diagnosis confirmed on computed tomography (CT).During the following 24 h, BM's respiratory function deteriorated and arterial blood gas analysis revealed a severe acidosis. He was transferred to a high dependency unit and continuous positive airways pressure, broad-spectrum antibiotics and total parenteral nutrition (TPN) commenced. His hypoxia continued to worsen however and he was endotracheally intubated and admitted to the intensive We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…3 It can lead to massive haemorrhage into the gastrointestinal tract or peritoneal cavity, and results in death in 20-40% of cases. [3][4][5] Case report…”

mentioning

confidence: 99%

See 2 more Smart Citations

The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

Skipworth

Raptis

Brennand

et al. 2009

annals

View full text Add to dashboard Cite

show abstract

“…10 Massive haemorrhage into the gastrointestinal (GI) tract or peritoneal cavity from VAPAs can result in death in 20-40% of cases. 9,11,12 Whereas spontaneous thrombosis has been described rarely, 4 VAPAs usually require treatment in the form of surgical, 13 endovascular, 14 or combined approaches. 5 We describe a case, and review all similar reports, of coil migration following endovascular exclusion of a visceral artery pseudoaneurysm.…”

Section: Introductionmentioning

confidence: 99%

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

Skipworth

Morkane

Raptis

et al. 2011

annals

View full text Add to dashboard Cite

INTRODUCTIONWe describe a case of metallic, angiographic coil migration, following radiological exclusion of a gastroduodenal artery pseudoaneurysm secondary to chronic pancreatitis. PATIENTS AND METHODS A 55-year-old man presented to the out-patient clinic with chronic, intermittent, post-prandial, abdominal pain, associated with nausea, vomiting and weight loss. He was known to have chronic pancreatitis and liver disease secondary to alcohol abuse and previously underwent angiographic exclusion of a gastroduodenal artery pseudoaneurysm. During subsequent radiological and endoscopic investigation, an endovascular coil was discovered in the gastric pylorus, associated with ulceration and cavitation. This patient was managed conservatively and enterally fed via naso-jejunal catheter endoscopically placed past the site of the migrated coil. This patient is currently awaiting biliary bypass surgery for chronic pancreatitis, and definitive coil removal will occur concurrently. CONCLUSIONS Literature review reveals that this report is only the eighth to describe coil migration following embolisation of a visceral artery pseudoaneurysm or aneurysm. Endovascular embolisation of pseudoaneurysms and aneurysms is generally safe and effective. More common complications of visceral artery embolisation include rebleeding, pseudoaneurysm reformation and pancreatitis.

show abstract

Angiographic Intervention in Patients With a Suspected Visceral Artery Pseudoaneurysm Complicating Pancreatitis and Pancreatic Surgery

Kalva¹,

Yeddula²,

Wicky³

et al. 2011

Arch Surg

View full text Add to dashboard Cite

show abstract

Endovascular Management of Major Arterial Hemorrhage as a Complication of Inflammatory Pancreatic Disease

Cited by 39 publications

References 21 publications

The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

Angiographic Intervention in Patients With a Suspected Visceral Artery Pseudoaneurysm Complicating Pancreatitis and Pancreatic Surgery

Contact Info

Product

Resources

About