Evidence for a central role for selective mesenteric angiography in the management of the major vascular complications of pancreatitis.
BACKGROUND
Although mesenteric angiography and embolization are established radiologic procedures, the evidence-base to aid decision making regarding selection of these procedures in the emergent situation in patients with hemorrhagic complications of pancreatitis is limited.


METHODS
A retrospective analysis of 19 patients with hemorrhagic complications of pancreatic inflammatory disease (acute pancreatitis, chronic pancreatitis, and pseudocyst) referred over a 4-year period and identified at the point of mesenteric angiography in order to determine the influence of interventional radiologic maneuvers on outcome.


RESULTS
Mesenteric angiography localized bleeding in 15 (79%), with 11 (58%) embolizations undertaken. There was one (9%) procedure-related complication and 3 (27%) rebleeds. Of 11 patients undergoing embolization, 8 (73%) required no further intervention for bleeding and 8 (73%) survived.


CONCLUSIONS
Mesenteric angiography is valuable in localizing bleeding in patients with major vascular complications of pancreatic inflammatory disease. Angiographic embolization can achieve definitive hemostasis and stabilize a critically ill patient to permit disease reappraisal.
Beattie
Garth C
GC
Department of Surgical and Clinical Sciences, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Hardman
Jonathan G
JG
Redhead
Doris
D
Siriwardena
Ajith K
AK
D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy; D000792:Angiography / Q000379:methods; D004621:Embolization, Therapeutic; D019317:Evidence-Based Medicine; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008643:Mesentery / Q000098:blood supply / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications*; D010195:Pancreatitis / Q000150:complications*; D012189:Retrospective Studies; D012985:Software Design; D016896:Treatment Outcome