HEMORRHAGIC COMPLICATIONS OF PANCREATITIS - PRESENTATION, DIAGNOSIS AND MANAGEMENT

Massive haemorrhage is an uncommon complication in pancreatitis. Most affected patients suffer from chronic disease with associated pseudocy st. We present five patients (four male) with a mean age of 41 years ( range 34-48 years). All patients had alcohol-induced pancreatitis comp licated either by haematemesis (3), intraperitoneal haemorrhage (1) or both haematemesis and intraperitoneal haemorrhage (1). Source of blee ding was pseudocyst wall (2), splenic artery pseudoaneurysm (2) and sp lenic artery rupture (1). Distal pancreatectomy and splenectomy was pe rformed in two patients, intracystic ligation and drainage in two, and packing with subsequent external drainage in one. Rebleeding occurred in two patients and required subsequent distal pancreatectomy and spl enectomy in one; the other patient died of splenic rupture. No rebleed ing and no mortality occurred after resection. Primary pancreatic rese ction is recommended whenever possible. Other management options inclu de embolisation and ligation.