Hemorrhage complicating the course of severe acute pancreatitis

Abstract

Backgrounds/Aims: The course of severe acute pancreatitis (SAP) complicated by hemorrhage is associated with poor outcome. Methods: Twenty-four (13%) out of 183 cases of SAP had hemorrhagic complications-12 intraabdominal & 12 intraluminal, 13 had major & 11 had minor and 16 had de-novo & 8 post-surgical bleeding. The mean duration of pancreatitis prior to bleeding was 27±27.2 days. Results: Predictors of haemorrhage on univariate analysis were delayed admission (0.037), more than one organ failure (p=0.008), presence of venous thrombosis (p=0.033), infective necrosis (0.001) and systemic sepsisbacterial (0.037) & fungal (p=0.032). On multivariate analysis infected necrosis (OR=11.82) and presence of fungal sepsis (OR=3.73) were the significant factors. Patients presenting with more than one organ failure and bacterial sepsis had borderline significance on multivariate analysis. Need for surgery (50% vs. 12.6%), intensive care stay (7.4±7.9 vs. 5.4±5.2 days) and mortality (41.7% vs. 10.7%) were significantly higher in patients who suffered haemorrhage. Seven of the 13 with major bleeding had pseudoaneurysms-4 were embolized, 4 needed surgery including 1 embolization failure. Seven with intraabdominal bleeding required surgical intervention, 2 had successful embolization and 3 had expectant management. CT severity index and surgical intervention, were significantly associated with intraabdominal bleeding. Organ failure, presence of pseudoaneurysm and surgical intervention were associated with major bleeding. Conclusions: Hemorrhage in SAP was associated with increased morbidity and mortality. Infected necrosis accentuated the degradation of the vessel wall, which predispose to hemorrhage. Luminal bleeding may be indicative of erosion into the adjacent viscera by the pseudoaneurysm.

Adolescent Acute Pancreatitis Complicated With Pseudoaneurysms and Venous Thrombosis

“…In this case, we were in a therapeutic dilemma between bleeding prevention and anticoagulation therapy. Hemorrhage is one of the vascular complications of AP and is associated with high mortality and morbidity [ 3 , 4 ]. Especially, pseudoaneurysms with AP require intensive management because of their vulnerability to rupture [ 3 ].…”

“…Hemorrhage is one of the vascular complications of AP and is associated with high mortality and morbidity [ 3 , 4 ]. Especially, pseudoaneurysms with AP require intensive management because of their vulnerability to rupture [ 3 ]. An arterial pseudoaneurysm is a ruptured vessel with a surrounding hematoma in communication with the vessel lumen.…”

Hemosuccus Pancreaticus Following Acute Pancreatitis in a 12-years-old Boy Secondary to Pancreatic Pseudoaneurysm Treated With Endovascular Coil Embolization

“…ERCP = endoscopic retrograde cholangiopancreatography; MIP, maximum intensity projection; MRCP = magnetic resonance cholangiopancreatography. related to pseudoaneurysms (6,7). Bleeding from pseudoaneurysms is more common in chronic compared to acute pancreatitis and was reported to occur in 7.1% versus 3.2% of patients respectively in a large recent adult retrospective study (8).…”

“…There are no large-scale studies on the incidence of hemorrhagic complications in pediatric acute pancreatitis. The reported incidence in adults varies widely between 1% and 23% ( 6 ). In 2 large adult series 17% and 33% of significant bleeding complications of acute pancreatitis were related to pseudoaneurysms ( 6 , 7 ).…”

Progress and future prospects of hemostatic materials based on nanostructured clay minerals

“…1 However, in cases of military conflicts, accidents, surgery, and pathological conditions, uncontrolled hemorrhage poses a significant threat to life and health. [2][3][4][5][6] These incidents are often accompanied by serious complications, including hypothermia, acidosis, coagulation disorders, multiple organ failure and hemorrhagic shock, which in turn impede physiological hemostasis. [7][8][9] Approximately 30% to 40% of traumatic mortality worldwide is attributed to massive bleeding, highlighting the urgent need for developing biosafe and effective hemostatic materials in the global medical system.…”