Possibilities of endovascular intervention for management of acute pancreatitis-related bleeding

Abstract

Introduction. Acute pancreatitis (AP) is a widespread and severe pathology that can be accompanied by a number of complications that not only complicate its therapy, but also significantly increase mortality. A special danger is erosive bleeding accompanying acute destructive pancreatitis. Erosive bleeding requires immediate diagnostic procedures – computed tomography, magnetic resonance imaging, ultrasound, but the most informative method is direct angiography. The aim of the study. To assess the effectiveness of X-ray endovascular interventions for massive erosive bleeding in patients with acute destructive pancreatitis. Materials and methods. X-ray endovascular interventions were used in 9 patients aged 35 to 73 years who had massive erosive bleeding as a complication of acute destructive pancreatitis. Bleeding was observed in the postoperative period against the background of receiving a full complex of infusion and conservative therapy. Bleeding developed in the first two days in 2 patients and in the first two weeks in 7 patients. Endovascular intervention was performed to stop the bleeding Results and discussion. In the near future, bleeding stopped in 9 patients (100%). On the second day, two patients with hepatic artery embolization experienced a recurrence of bleeding. Repeated angiography and embolization attempts were ineffective and the patients died. In patients with embolization a. pancreato-duodenalis and a. lienalis bleeding did not recover. Thus, we obtained significantly better results – 7 out of 9 patients survived (77.7%), regardless of the severity of the condition and the prognosis. Conclusions. Adherence to this tactic in the treatment of bleeding in acute destructive pancreatitis has shown high efficiency, especially in superselective embolization with identification of the source of bleeding.