Summary
Acute bleeding is a rare, but frequently fatal complication of pancreatitis. Bleeding into the gastrointestinal tract may occur owing to gastric or duodenal erosions, peptic ulcers, or varices in the esophagus, stomach, or colon following splenic vein thrombosis, or intraperitoneally from eroded vessels in pancreatic pseudocysts or expanding pseudoaneurysms. We report a novel case of massive intraperitoneal bleeding owing to tryptic erosions of the splenic vein in a patient recovering from acute pancreatitis. Diagnosis of the bleeding was made by ultrasound and ultrasound-guided blood aspiration. The source of the bleeding was identified intraoperatively, and a left-sided pancreatectomy and a splenectomy were performed.
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References
Neher M, Kümmerle F. Gastrointestinale Komplikationen bei akuter Pankreatitis. Dtsch Med Wochenschr 1978; 103: 1400–1404.
Simma W, Brücke P. Zur Diagnostik und Therapie der oberen gastrointestinalen Blutung bei der akuten Pankreatitis und deren Folgezustände. Wien Klin Wochenschr 1976; 88: 592–595.
Imrie CW, Whyte AS. A prospective study of acute pancreatitis. Br J Surg 1975; 62: 490–494.
Lankisch PG, Banks PA. Pancreatitis. Springer, Berlin, 1998.
Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990; 174: 331–336.
Kirby CK, Senior JR, Howard JM, Rhoads JE. Death due to delayed hemorrhage in acute pancreatitis. Surg Gynecol Obstet 1955; 100: 458–462.
Puolakkainen P, Lempinen M, Schröder T. Fatal pancreatitis. A study of 64 consecutive cases. Acta Chir Scand 1986; 152: 379–383.
Shankar S, Russell RCG. Haemorrhage in pancreatic disease. Br J Surg 1989; 76: 863–866.
Gadacz TR, Trunkey KD, Kieffer RF Jr. Visceral vessel erosion associated with pancreatitis. Case reports and a review of the literature. Arch Surg 1978; 113: 1438–1440.
Ettman IK, Kongtawng T. Massive gastrointestinal bleeding and perforation of a duodenal diverticulum with coexisting pancreatitis. South Med J 1977; 70: 761–763.
Greenstein A, DeMaio EF, Nabseth DC. Acute hemorrhage associated with pancreatic pseudocysts. Surgery 1971; 69: 56–62.
Waltman AC, Luers PR, Athanasoulis CA, Warshaw AL. Massive arterial hemorrhage in patients with pancreatitis. Complementary roles of surgery and transcatheter occlusive techniques. Arch Surg 1986; 121: 439–443.
Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg 1983; 118: 45–51.
Renner IG, Savage WT III, Pantoja JL, Renner VJ. Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dis Dis Sci 1985; 30: 1005–1018.
Rogers C, Klatt EC. Splenic vein thrombosis in patients with acute pancreatitis. Int J Pancreatol 1989; 5: 117–121.
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Müller, C.H., Lahnert, U., Schafmayer, A. et al. Massive intraperitoneal bleeding from tryptic erosions of the splenic vein. International Journal of Pancreatology 26, 49–52 (1999). https://doi.org/10.1385/IJGC:26:1:49
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DOI: https://doi.org/10.1385/IJGC:26:1:49