Diagnostic Pitfalls and Therapeutic Strategies in the Treatment of Pancreatic Duct Haemorrhage

Autor: I. N. Marks, P. C. Bornman, G. Mclauchlin, Jake E. J. Krige, J. Thomson, P. J. Gallagher, John S. Terblanche
Jazyk: angličtina
Rok vydání: 1997
Předmět:
Zdroj: HPB Surgery
Scopus-Elsevier
HPB Surgery, Vol 10, Iss 5, Pp 293-297 (1997)
ISSN: 1607-8462
0894-8569
Popis: Haemorrhage via the pancreatic duct, a rare cause of upper gastrointestinal bleeding (GIB), often poses a diagnostic dilemma. We analysed our experience with 10 patients (8 men, 2 women; mean age 44 years, range 34 – 62) treated during a 12 year period. All had a history of alcohol abuse and presented with major upper GIB requiring a median of 8 units (range 2 – 40) blood, transfusion. Nine had upper abdominal pain at the time of admission and nine had a history of pancreatitis. Upper gastroduodenal endoscopy (median 4; range 1 – 9), was diagnostic in only one. Side-viewing endoscopy showed bleeding from the pancreatic duct in 7 of 8 patients. Visceral aneurysms were demonstrated in 7 of 9 patients in whom coeliac angiography was carried out: (splenic artery 4, gastroduodenal artery 2, and pancreaticoduodenal artery 1). Two of 4 selective embolisations were successful. Six patients underwent distal pancreatectomy, 1 had gastroduodenal artery ligation and 1 died of coagulopathy following a total pancreatectomy. Pancreatic duct haemorrhage should be considered in patients with unexplained recurrent upper GIB, alcohol abuse and epigastric pain, particularly in those with established chronic pancreatitis. Selective angiography is essential for diagnosis and management. For bleeding sites in the head of the pancreas, embolisation should be attempted to avoid major resection. Distal pancreatectomy is preferred for splenic artery lesions.
Databáze: OpenAIRE
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