Hemorrhagic Complications of Pancreatitis

  • G. Flati
  • P. Negro
  • B. Porowska
  • D. Flati
  • M. Carboni


Bleeding in pancreatitis may be due either to gastroduodenal causes (e.g., acute gastric erosions, mucosal congestions, peptic ulceration, Mallory-Weiss syndrome, and alcoholic gastritis), which are usually managed with conservative treatment [1], or to direct involvement of vascular structures by pancreatitic local sequelae. The latter, although uncommon, is usually characterized by massive hemorrhage, which is considered the most severe and rapidly lethal complication of pancreatitis [2, 3]. It may be associated with either acute or chronic pancreatitis and is caused by major vessels’ erosion, followed in most cases by vessel disruption or pseudoaneurysm formation. Pseudocysts, severe inflammation, regional necrosis, and infection are the most important pathogenetic factors [4, 5]. Although the incidence of major bleeding in pancreatitis is relatively low (1.7%–2.5%), it is associated with a prohibitively high mortality rate reaching 40%–80% [6, 7, 8].


Acute Pancreatitis Chronic Pancreatitis Pancreatic Duct Necrotizing Pancreatitis Hemorrhagic Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Marks NI, Banks S, Louw JH, Farman J (1967) Peptic ulceration and gastrointestinal bleeding in pancreatitis. Gut 8:253–259PubMedCrossRefGoogle Scholar
  2. 2.
    Stroud WH, Cullom JW, Anderson MC (1981) Hemorrhagic complications of severe pancreatitis. Surgery 90/4:657–665PubMedGoogle Scholar
  3. 3.
    Brown RA, Immelman EJ, Harries-Jones EP (1985) Pancreatic duct haemorrhage. Br J Surg 72/3:223–224PubMedCrossRefGoogle Scholar
  4. 4.
    Breitenecker R (1960) Fatal gastrointestinal hemorrhage due to chronic relapsing pancreatitis. Report of two cases, one with abscess and one with pseudocyst formation. New Engl J Med 260:1167–1169CrossRefGoogle Scholar
  5. 5.
    Eckhauser EF, Stanley JC, Zelenock GB, Borlaza GS, Freier TD, Lindenauer MS (1980) Gastroduodenal and pancreaticoduodenal artery aneurysms: a complication of pancreatitis causing spontaneous gastrointestinal hemorrhage. Surgery 88:335–344PubMedGoogle Scholar
  6. 6.
    Waltman AC, Luers PR, Athanasoulis CA, Warshaw AL (1986) Massive arterial hemorrhage in patients with pancreatitis. Arch Surg 121:439–443PubMedGoogle Scholar
  7. 7.
    Bretagne JF, Heresbach D, Darnault P, Raoul JL, Gosselin M, Carsin M, Gastard J (1990) Pseudoaneurysms and bleeding pseudocysts in chronic pancreatitis: radiological findings and contribution to diagnosis in 8 cases. Gastrointest Radiol 15:9–16PubMedCrossRefGoogle Scholar
  8. 8.
    Henne-Bruns D, Froschle G, Grimm H, Kremer B (1991) Acute gastrointestinal bleeding as a complication of pancreatic pseudocysts. Hepatogastroenterology 38:75–77PubMedGoogle Scholar
  9. 9.
    Negro P, Flati G, Flati D, Porowska B, Tuscano D, Bianchini A, Carboni M (1985) Massive fulminant hemorrhage due to splenic rupture in pancreatitis. Dig Surg 2:231–234CrossRefGoogle Scholar
  10. 10.
    Shankar S, Rüssel RCG (1989) Haemorrhage in pancreatic disease. Br J Surg 76:863–866PubMedCrossRefGoogle Scholar
  11. 11.
    Stabile BE, Wilson SE, Debas HT (1983) Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg 118:45–51PubMedGoogle Scholar
  12. 12.
    Berne TV, Edmondson HA (1966) Colonic fistulization due to pancreatitis. Am J Surg 111:359–363PubMedCrossRefGoogle Scholar
  13. 13.
    Poole GV, Wallenhaupt SL (1984) Massive rectal bleeding from colonic fistula in pancreatitis. Arch Surg 119:732–735PubMedGoogle Scholar
  14. 14.
    Walter JF, Chuang VP, Bookstein JJ, Reuter SR, Cho KJ, Pulmano CM (1977) Angiography of massive hemorrhage secondary to pancreatic disease. Diagn Radiol 124:337–342Google Scholar
  15. 15.
    Huizinga WKJ, Kaiideen JM, Bryer JV, Bell PSH, Baker LW (1984) Control of major haemorrhage associated with pancreatic pseudocysts by transcatheter arterial enbolization. Br J Surg 71:133–136PubMedCrossRefGoogle Scholar
  16. 16.
    Triller VJ, Seiler C, Blumgart LH (1989) Akute intestinale Blutung bei pankreatikopseudozysto-kolischer Fistel. Fortschr Geb Rontgenstr 151/5: 527–531CrossRefGoogle Scholar
  17. 17.
    Vujic I, Andersen BL, Stanley JH, Gobien RP (1984) Pancreatic and peripancreatic vessels: embolization for control of bleeding pancreatitis. Radiology 150:51–55PubMedGoogle Scholar
  18. 18.
    Falkoff GE, Taylor KJW, Morse S (1986) Hepatic artery pseudoaneurysms: diagnosis with real-time and pulsed Doppler US. Radiology 158:55–56PubMedGoogle Scholar
  19. 19.
    Beger HG, Buchler M, Bittner R, Block S, Nevalainen T, Roscher R (1988) Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg 75:207–212PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • G. Flati
    • 1
  • P. Negro
  • B. Porowska
  • D. Flati
  • M. Carboni
  1. 1.II Department of SurgeryUniversity of Rome “La Sapienza”RomaItalia

Personalised recommendations