Introduction Life threatening haemorrhage from vascular complications of pancreatitis are rare but, need to be effectively managed even in a district general hospital (DGH) setting. We report our experience of gastrointestinal bleeding due to local complications of pancreatitis which were effectively managed by radiological intervention.
Methods All mesenteric angiograms done in our hospital over a period of 7 years were reviewed retrospectively along with their case notes. All such procedures in our hospital were performed by a single interventional radiologist.
Results Out of 31 patients identified in this period 28 patients had bleeding secondary to peptic ulcers. Three patients had bleeding due to vascular complications of pancreatitis. Patient I: A 58-year-old lady had developed pancreatic pseudocyst secondary to azathioprine induced pancreatitis. He presented with hematochezia but, gastroscopy was normal. Urgent mesenteric angiogram revealed beaded pancreatico-duodenal artery in spasm adjacent to the pseudocyst. This was embolised with control of upper GI haemorrhage. Patient II: A 59-year-old man with alcohol induced pancreatitis and pseudocyst presented with UGI bleeding. OGD revealed blood in the stomach and duodenum but, no source of bleeding was identified. Mesenteric angiogram revealed pseudoaneurysm of the gastroduodenal artery adjacent to the pseudocyst which was embolised with control of haemostasis. Patient III: A 64-year-old man with a known pseudocyst presented with UGI bleeding. CT angiogram revealed bleeding into the pseudocyst secondary to a pseudoaneurysm of the gastroduodenal artery. This was treated with mesenteric emobolisation.
Conclusion Haemorrhage due to vascular complications of pancreatitis usually present as a life threatening emergency and associated haemodynamic compromise. Surgery is often difficult due to the lack of trained pancreatico-biliary surgeons in most DGHs. Radiological embolisation is an effective treatment which should be readily available in hospitals admitting such patients. Foundation trusts ought to invest in such resources to prevent unwarranted mortality.
Competing interests None declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.