Arterial erosions in acute pancreatitis.
Acute pancreatitis was observed in 492 patients. Fourteen (2.8%) developed an arterial erosion revealed by a haemorrhage either in the digestive lumen, in the peritoneum or via previously placed drainage. The eroded artery was the splenic artery in six patients, a pancreatico-duodenal artery in five patients. An initial haemostasis was attempted by: a) embolization in four patients: one died; the three others had bleeding recurrence. b) splenocorporeal pancreatectomy in four patients, three had bleeding recurrence. c) arterial ligature in four patients: three had bleeding recurrence. Secondary haemostatic procedures were performed in ten patients but a durable haemostasis was achieved in only five patients: two had a pancreatic resection and three were treated by a redo-binding. It is noteworthy that durable haemostasis could not be obtained neither by embolization nor by ligature in necrotic tissues. This could explain the difference in the results of arterial erosion treatments in chronic and in acute pancreatitis. Therefore, it is suggested that haemostatic procedures should be performed away from necrotic tissues, or eventually done after their removal.
Testart
J
J
Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen.
Boyet
L
L
Perrier
G
G
Clavier
E
E
Peillon
C
C
D000328:Adult; D000368:Aged; D000792:Angiography; D004386:Duodenum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries*; D004621:Embolization, Therapeutic; D016145:Endoscopy, Digestive System; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000628:therapy*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D014057:Tomography, X-Ray Computed