ARTERIAL COMPLICATIONS OF PANCREATITIS - DIAGNOSTIC AND THERAPEUTIC ROLE OF RADIOLOGY

Hemorrhage from pseudoaneurysm complicating pancreatitis is an infrequ ent but very severe condition. In most cases, acute, massive gastroint estinal bleeding is typical at onset, and prognosis of these cases is usually poor. Nine cases of arterial lesions secondary to pancreatic i nflammation are presented, eight related to chronic pancreatitis and o ne to acute postoperative pancreatitis. Five patients were evaluated d uring emergency episodes because of acutely gastrointestinal bleeding (four cases), and pseudocyst acute bleeding (one case). Four patients were selectively evaluated: three had a history of self-limiting gastr ointestinal hemorrhage, whereas one had experienced no episodes of gas trointestinal hemorrhage. Angiography was performed in all cases and w as always diagnostic, even in the two cases of very small pseudoaneury sms. Transcatheter arterial blockade was attempted in five patients an d failed to control the hemorrhage in one acutely bleeding patient bec ause of irreversible shock. Two cases of pancreatic hemorrhage not rel ated to a pseudocyst were effectively and permanently treated by embol ization. A case of a pseudoaneurysm associated with a pseudocyst requi red surgery in addition to embolization for a definitive treatment. Ne vertheless, when a pseudoaneurysm or a pseudocyst hemorrhages acutely, transcatheter arterial blockade can control the hemorrhage and improv e the hemodynamic status of the patient before surgery.