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Langenbeck's Archives of Surgery

, Volume 389, Issue 6, pp 504–510 | Cite as

Prevalence and treatment of bleeding complications in chronic pancreatitis

  • H. Bergert
  • F. Dobrowolski
  • S. Caffier
  • A. Bloomenthal
  • I. Hinterseher
  • H. D. Saeger
Original Article

Abstract

Objectives

As spontaneous major haemorrhage in patients with chronic pancreatitis is rare, limited data have been reported, and no evidence-based guidelines are currently available regarding the optimal treatment modality.

Patients and methods

We report our experience with 36 patients with severe bleeding complications from a series of 541 patients presenting with chronic pancreatitis (representing a prevalence of 6.7% of admitted patients), treated in one surgical department over a period of 9.5 years, with a median follow-up of 4.1 years.

Results

Haemorrhage was indirectly related to chronic pancreatitis in eight patients (22.2%) with ulcer or variceal bleeding. Three patients (8.4%) demonstrated spleen infarction or rupture. The most common causes of major haemorrhage were pseudoaneurysms in 25 patients (69.4%). Nine of them were treated with primary embolization. Sixteen patients with pseudoaneurysms underwent surgery. The only mortalities (8.3%) observed were from bleeding-associated complications of pseudoaneurysms. Two patients died after surgery, and one after primary embolization. We observed a higher re-bleeding rate after surgery (25% vs 11% after embolization). The presence of haemorrhagic shock, and the amount of blood transfused, were significant determinants of hospital mortality. Patient age, pseudoaneurysm location, and treatment modality had no significant influence on mortality.

Conclusions

Any haemodynamically stable patient with haemorrhage due to arterial pseudoaneurysms should undergo angiography with embolization when technically possible. If there are no other pancreas-related indications for surgery, embolization remains the definitive treatment. If embolization is not available or has failed, surgery is indicated, although perioperative morbidity will be higher.

Keywords

Chronic pancreatitis Acute haemorrhage Bleeding complications Embolization 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • H. Bergert
    • 1
    • 2
  • F. Dobrowolski
    • 1
  • S. Caffier
    • 3
  • A. Bloomenthal
    • 2
  • I. Hinterseher
    • 1
  • H. D. Saeger
    • 1
  1. 1.Department of Visceral, Thoracic, and Vascular SurgeryTechnical University of DresdenDresdenGermany
  2. 2.Department of SurgeryUniversity of MassachusettsWorcesterUSA
  3. 3.Department of RadiologyTechnical University of DresdenDresdenGermany

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