Empirical coil embolization of splenic artery as a salvage life saving procedure in post pancreatectomy hemorrhage and hemosuccus pancreaticus

Abstract

Introduction: Computerised Tomography Angiogram (CTA) is the diagnostic modality in Post pancreatectomy Haemorrhage (PPH) and Hemosuccus Pancreaticus (HP). However, occasionally, the offending aneurysm or the source of bleed may not be evident by CTA or conventional angiography. Intraluminal bleeds, especially after Dunking Pancreaticojejunostomy, may be from small pseudoaneurysms in the territory of splenic artery or from cut end of pancreas that are difficult to pick up by CTA. We evaluated the efficacy of empirical segmental Coil embolisation of pancreatic segment of splenic artery in the setting of intraluminal PPH as well as HP following Acute /Chronic pancreatitis. Methods: A cross sectional study was done by analysing the prospectively held pancreatic database from January 2009-december 2018. All consecutive patients with PPH following any type of Pancreatectomy as well as Hemosuccus Pancreaticus (in Acute and chronic pancreatitis) who underwent empirical coil embolization of splenic artery were included. Those who showed blush on CTA or conventional angiography and those who were managed primarily with surgery for PPH were excluded. The rebleeding and mortality rates were assessed at 72-hour and 30-days respectively. Results: There were 137 Pancreaticoduodenectomies, 68 Distal Pancreatectomies, 11 median pancreatectomies and 134 admissions for Acute pancreatitis/ exacerbation of Chronic pancreatitis during the period. Overall, 6/7 (85.7%) with negative CTA had successful coil embolization. No re-intervention/ continued bleed/ splenic infarcts/ no requirement of transfusion or abscess were seen in any of these six patients. Conclusion: Empirical coil embolization of splenic artery in pancreatic bleed holds promise as a salvage life-saving procedure.