Management and Outcome of Bleeding Pseudoaneurysm
Management and Outcome of Bleeding Pseudoaneurysm
Background: A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH) in managing of bleeding pseudoaneurysms associated with chronic pancreatitis.
Methods: The medical records of 9 patients (8 males and 1 female; age range, 28 - 71 years; median, 36 years) with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78%) was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7), computed tomographic (4/7), ultrasound (2/5), and surgical (2/2) findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 - 87 months).
Results: Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%). Angiography determined correct diagnosis in 7 patients (7/7, 100%). The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4) or elective (n = 3) surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5) and 89% (8/9). Five patients developed pseudocysts before treatment (n = 3) or following intervention (n = 2). Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality rate was 11% (1/9). Surgery-related mortality was 0%.
Conclusion: Angiography is valuable in localizing bleeding pseudoaneurysms. In this limited series, patients with bleeding pseudoaneurysms associated with chronic pancreatitis treated surgically seemingly obtained good outcomes.
A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare yet lethal complication. Mortality rates can reach as high as 40% depending on patient clinical status, site and characteristics of the bleeding lesion, and the surgical procedure employed. Optimal treatment of bleeding pancreatic pseudoaneurysm associated with chronic pancreatitis remains controversial. Previous studies confirmed the effectiveness of arteriographic embolization for temporary and definite control of bleeding from pseudoaneurysms associated with chronic pancreatitis. Some authors have argued that embolization does not cure a diseased pancreas and subsequent surgery is always indicated. No evidence-based guidelines exist regarding the optimal treatment modality as limited data is available. This study describes the experience at Chang Gung Memorial Hospital (CGMH) in managing 9 patients diagnosed with bleeding pseudoaneurysms associated with chronic pancreatitis. The medical records of these patients over a period of 12 years were retrospectively reviewed.
Abstract and Background
Abstract
Background: A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH) in managing of bleeding pseudoaneurysms associated with chronic pancreatitis.
Methods: The medical records of 9 patients (8 males and 1 female; age range, 28 - 71 years; median, 36 years) with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78%) was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7), computed tomographic (4/7), ultrasound (2/5), and surgical (2/2) findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 - 87 months).
Results: Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%). Angiography determined correct diagnosis in 7 patients (7/7, 100%). The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4) or elective (n = 3) surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5) and 89% (8/9). Five patients developed pseudocysts before treatment (n = 3) or following intervention (n = 2). Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality rate was 11% (1/9). Surgery-related mortality was 0%.
Conclusion: Angiography is valuable in localizing bleeding pseudoaneurysms. In this limited series, patients with bleeding pseudoaneurysms associated with chronic pancreatitis treated surgically seemingly obtained good outcomes.
Background
A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare yet lethal complication. Mortality rates can reach as high as 40% depending on patient clinical status, site and characteristics of the bleeding lesion, and the surgical procedure employed. Optimal treatment of bleeding pancreatic pseudoaneurysm associated with chronic pancreatitis remains controversial. Previous studies confirmed the effectiveness of arteriographic embolization for temporary and definite control of bleeding from pseudoaneurysms associated with chronic pancreatitis. Some authors have argued that embolization does not cure a diseased pancreas and subsequent surgery is always indicated. No evidence-based guidelines exist regarding the optimal treatment modality as limited data is available. This study describes the experience at Chang Gung Memorial Hospital (CGMH) in managing 9 patients diagnosed with bleeding pseudoaneurysms associated with chronic pancreatitis. The medical records of these patients over a period of 12 years were retrospectively reviewed.
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