Hemorrhage in acute pancreatitis: should gastrointestinal bleeding be considered an organ failure?
OBJECTIVE
To define the magnitude, causes, risk factors, and consequences of hemorrhage in acute pancreatitis (AP).


METHODS
Consecutive patients with AP were studied for hemorrhagic complication and its impact on mortality. Patients with gastrointestinal (GI) hemorrhage or hemorrhage within the pancreatic bed were managed with transfusions, endotherapy, angiographic embolization, or surgery as appropriate.


RESULTS
Of 449 patients, 28 (6.2%) developed hemorrhage. The mean age of patients with hemorrhage was 39 +/- 14 years and 25 (89%) were men. Of the 28 patients, 16 had GI hemorrhage, and 12 had hemorrhage into the pancreatic bed. Median interval between the onset of AP and hemorrhage was 26.5 days. Pancreatic necrosis, sepsis, fluid collection, and organ failure were found to be risk factors for hemorrhage. Five patients had pseudoaneurysms; angiographic embolization was successful in 4 of them. The mortality rate in bleeders was higher than that in nonbleeders (28.6% vs 13%; P = 0.02). None of the patients died as a direct consequence of hemorrhage except 1 patient who died after surgery for failed embolization of bleeding pseudoaneurysm. Deaths were mainly caused by sepsis and multiorgan failure.


CONCLUSIONS
Hemorrhagic complications are usually late manifestations in the course of severe pancreatitis and per se have little bearing on mortality.
Sharma
Praveen Kumar
PK
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Madan
Kaushal
K
Garg
Pramod Kumar
PK
D000208:Acute Disease; D000328:Adult; D018450:Disease Progression; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009336:Necrosis; D010182:Pancreatic Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index