Affiliation:
1. Centre de Chirurgie Digestive, Hǒpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
Abstract
Abstract
Spontaneous haemorrhage associated with chronic pancreatitis in 17 patients was related to a pseudocyst in 15 (88 per cent) patients and to pancreatic lithiasis (one patient) or to infarction-rupture of the spleen (one patient). Bleeding was massive in six patients and intermittent in 11. It resulted from erosion of the gastroduodenal or the splenic artery in four patients. Bleeding into the pancreatic duct occurred in four patients and erosion of the duodenum by a bleeding pseudocyst in five. Haemorrhage was confined to a pseudocyst in six patients and was intraperitoneal in two. Of the 15 patients with bleeding pseudocysts, ten underwent primary pancreatic resection (eight proximal and two distal pancreatectomies) with no mortality but four had early complications. Four of the five patients who underwent transcystic ligation of bleeding vessels and pseudocyst drainage had postoperative complications: one died from sepsis and liver failure and three underwent reoperation for severe postoperative bleeding. Of these, two had proximal pancreatic resection with one death. The third patient had further suture ligation and external drainage. The overall postoperative mortality rate was 12 per cent and following emergency surgery 33 per cent. Favourable results were achieved in two-thirds of patients when the primary operative strategy could be directed towards the control of bleeding and removal of the affected pancreatic segment. Primary pancreatic resection, although technically demanding in the presence of haemorrhage, is recommended whenever possible for the treatment of bleeding pancreatic pseudocysts and pseudoaneurysms associated with chronic pancreatitis.
Funder
World Islamic Call Society
Publisher
Oxford University Press (OUP)
Reference27 articles.
1. Visceral vessel erosion associated with pancreatitis;Gadacz;Arch Surg,1978
2. Major gastrointestinal haemorrhage associated with pancreatic pseudocysts;Wolstenholme;Am J Surg,1974
3. Gastroduodenal and pancreaticoduodenal artery pseudoaneurysms: a complication of pancreatitis causing spontaneous gastrointestinal haemorrhage;Eckhauser;Surgery,1980
4. Hemosuccus pancreaticus secondary to ruptured splenic artery pseudoaneurysm;Starling;Dig Dis Sci,1979
5. Les haemorrhagies digestives au cours des pancreatites chroniques;Fekete;Gastroenlerol Clin Biol,1980
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