TREATMENT OF CHRONIC PANCREATITIS COMPLICATED BY BLEEDING

Abstract

Aim. To analyze the causes of bleeding in chronic pancreatitis patients and efficacy of different hemostatic techniques. Material and Methods. The study included 632 patients with chronic pancreatitis operated in 1981–2016. Pancreatic pseudocysts were observed in 404 cases (63.9%), bleeding – in 70 cases (17.3%). Conventional surgical treatment was applied in 49 cases (group 1), endovascular approach was used for 21 patients and 10 of them underwent additional surgery in the future (group 2). Bleeding into cyst’s cavity was in 22 patients (31.4%); cyst wall rupture followed by bleeding into gastrointestinal tract – in 30 (42.8%), into abdominal cavity – in 10 (14.3%), into retroperitoneal space – in 6 (8.6%), into pleural cavity – in 2 (2.8%) cases. Results. In group 1 18 (36.8%) patients underwent conventional surgical ligation of the vessels, drainage and tamponade of the pseudocyst; 8 (17.0%) patients – external drainage of pancreatic duct; 7 (14.5%) – vessel ligation followed by longitudinal pancreatojejunostomy; 8 (15.5%) – distal pancreatectomy; 2 (4.1%) – pancreatoduodenectomy; 2 (4.1%) – middle pancreatectomy; 4 (8.1%) – splenic artery ligation, splenectomy and external drainage of the pseudocyst. 4 patients with severe bleeding died in this group. Endovascular approach was applied in 21 cases of the 2nd group: embolization of splenic artery – in 11 (52.4%) cases, gastroduodenal artery – in 7 (33.3%) cases, gastroduodenal arch – in 3 (14.3%) cases. In 11 (52.4%) cases isolated false aneurysm embolization was performed. In another 10 (47.6%) cases endovascular approach was combined with open surgery. 1 (4.7%) patient died from severe posthemorrhagic complications and delayed endovascular treatment. Overall mortality due to hemorrhagic complications was 7.1%. Conclusion. Hemorrhagic complications developed in view of exacerbation of chronic pancreatitis. Surgical tactics was aimed at hemostasis, elimination of ductal hypertension and drainage of pseudocyst. Endovascular treatment is the most reliable that however does not exclude subsequent open pancreatic surgery. Minimally invasive drainage of ducts and pseudocysts was also useds.