INTRAABDOMINAL HEMORRHAGE COMPLICATING SURGICAL-MANAGEMENT OF NECROTIZING PANCREATITIS

Surgical management of necrotizing pancreatitis (NP) may result in sig nificant intraabdominal hemorrhage requiring intervention. To determin e the incidence and management of hemorrhage complicating operative ma nagement of NP, we analyzed retrospectively all patients undergoing op erative treatment of NP between 1985 and 1994, Thirteen of 61 patients (21%) developed intraabdominal hemorrhage requiring intervention. The five patients (38%) who experienced more than one bleeding episode ha d undergone more prior operative debridements (mean of 5.6 vs, 3.8), h ad had higher transfusion requirements during the first bleeding episo de (mean of 27.4 vs, 11.3 U of packed red blood cells), and had a high er hospital mortality (60 vs. 38%) compared to patients with only one bleeding episode. Coexistence of pancreatic and/or gastrointestinal fi stula was more common in patients who developed bleeding (36 vs, 11%). Seventeen bleeding sites (eight venous, seven arterial, two generaliz ed oozing) were identified, Angiography was successful in one of two p atients in whom it was employed, Surgical control was effective in the other 12 patients. There was no acute mortality related to hemorrhage ? but the hospital mortality was greater than in those without hemorrh age (46 vs. 21%). We conclude that significant hemorrhage complicates the surgical management of NP in similar to 20% of patients; while it can be effectively controlled surgically and does not lead to immediat e mortality, it may predict worse prognosis.