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

Pancreatitis: Preventing catastrophic haemorrhage

Richard Pt Evans  1 , Moustafa Mabrouk Mourad  1 , Gunraj Pall  1 , Simon G Fisher  1 , Simon R Bramhall  1
Affiliations
Review

Pancreatitis: Preventing catastrophic haemorrhage

Richard Pt Evans et al. World J Gastroenterol. .

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.

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Conflict of interest statement

Conflict-of-interest statement: None of the authors has any potential conflicting financial interests relevant to this article.

Figures

Figure 1
Figure 1
Computed tomography arterial and venous phase showing a pseudocyst (green arrows) eroding the splenic artery (blue arrows)[90].
Figure 2
Figure 2
Computed tomography arterial and venous phases showing a pseudoaneurysm in a patient with necrotizing pancreatitis.
Figure 3
Figure 3
Three-D coronal maximum-intensity-projection computed tomography image in a 45-year-old man who had remote history of pancreatitis presented with back pain showing 2.0-cm pseudoaneurysm (arrow) arising from splenic artery[91].
Figure 4
Figure 4
Splenic artery pseudoaneurysm before and after embolization. A: Post contrast computed tomography scan showing the pseudoaneurysm rising from the splenic artery; B: Pre embolization selective splenic arterial DSA angiography image showing pseudoaneurysm; C: Post embolization DSA image showing the coils inside the splenic artery with its resultant embolization[92].
See this image and copyright information in PMC

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