Angiographic Embolization Is an Effective Treatment of Severe Hemorrhage in Pancreatitis

Abstract

The aim of this study was to analyze the role of radiologic embolization as a diagnostic and therapeutic modality for severe hemorrhage in pancreatitis. All patients with pancreatitis who underwent mesenteric angiography for a 3-year period were identified and analyzed retrospectively. Nine separate bleeding episodes were treated with embolization (mean age, 56 years). This consisted of 6 patients who underwent primary angiographic embolization, with 3 patients requiring further embolization because of repeated bleeding from a different site. Most patients (83%) had chronic disease. The causative arteries were identified as splenic (6/9 patients), gastroduodenal (1/9 patients), left gastric (1/9 patients), and a small branch of the inferior mesenteric (1/9 patients). Clinical presentations were abdominal pain (3/9 patients), melena (3/9 patients), bleeding into retroperitoneal drain (2/9 patients), and hematemesis (1/9 patients). Bleeding was severe with an average drop in hemoglobin level of 6.3 g/dL. Of the 3 patients who required further embolization, all had splenic artery pseudoaneurysms and 2 patients experienced chronic pancreatitis with necrosis and proven peripancreatic infections. In all cases (9/9 patients), angiography succeeded in identifying and embolizing the causative vessel with a 1-year mortality of 0%. Angiographic embolization is an effective treatment of the life-threatening bleeding that occurs secondary to pancreatitis.