Multidisciplinary Cooperation in the Management of Serious Bleedings Complicating Necrotizing Pancreatitis – A Case Review

Česká verzia

Authors: J. Lacman; I. Buřič; F. Charvát; J. Mašková; Z. Fuksa ^*; J. Pudil ^**; F. Bělina ^**
Authors place of work: Radiodiagnostické oddělení ÚVN Praha ; Oddělení intenzivní péče chirurgických oborů ÚVN Praha ^*; Chirurgická klinika 2. LF UK a ÚVN, Praha ^**
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 10, s. 507-511.
Category: Monothematic special - Original

Summary

Acute necrotising pancreatitis is connected with a high complication rate. The most serious ones are hemorrhagic complications with bleeding from vascular structures erosions. Authors report a case of endovascular treatment of surgically untreatable lesion of portal vein. In this case stentgraft was successfully implanted to cover the erosion and stop the bleeding. Percutaneous transhepatic route was used.

Key words:
acute necrotising pancreatitis – bleeding – endovascular treatment – stentgraft

Zdroje

1. Di Paolo, M., Marradi, I. Haemorrhagic complication of acute necrotizing pankreatitis presenting with sudden death. J. Clin. Forensic. Med., 2006; 13(5): 271–273.

2. Mendelson, R. M., Anderson, J., Marshall, M., Ramsay, D. Vascular complications of pancreatitis. ANZ J. Surg., 2005 Dec; 75(12): 1073–1079.

3. Bergert, H., Dobrowolski, F., Caffier, S., Bloomenthal, A., Hinterseher, I., Saeger, H. D. Prevalence and treatment of bleeding complications in chronic pancreatitis. Langenbecks Arch. Surg., 2004 Nov; 389(6): 504–510.

4. Ferda, J., Novák, M., Kreuzberg, B. Výpočetní tomografie. Galén, 2002.

5. Krajina, A., Peregrin, J. H. Intervenční radiologie – Miniinvazivní terapie. Hradec Králové – Olga Čermáková, 2005.

6. Abbott, G. T., McDermott, V. G., Smith, T. P. Succesfull endovascular treatment of a celiac artery pseudoaneurysm complicating pankreatitis. J. Vasc. Interv. Radiol., 1996; 7: 103–106.

7. Appel, N., Duncan, J. R., Schuerer, D. J. E. Percutaneous stent-graft treatment of superior mesenteric and internal iliac artery pseudoaneurysms. J. Vasc. Interv. Radiol., 2003; 14: 917–922.

8. Arepally, A., Dagli, M., Hofmann, L. V., Kim, H. S., Cooper, M., Klein, A. Treatment of splenic artery aneurysma with use of a stent-graft. J. Vasc. Interv. Radiol., 2002; 13: 631–633.

9. Brountzos, E. N., Vagenas, K., Apostolopoulou, S. C., Panagiotou, I., Lymberopoulou, D., Kelekis, D. A. Pancreatitis-associated splenic artery pseudoaneurysm: endovascular treatment with self-expandable stent-grafts. Cardiovasc. Intervent Radiol., 2003; 26: 88–91.

10. Araoz, P. A., Andrews, J. C. Direct percutaneous embolization of visceral artery aneurysms: techniques and pitfalls. J. Vasc. Interv. Radiol., 2000; 11: 1195–1200.

11. Millonig, G., Graziadei, I. W., Waldenberger, P., Koenigsrainer, A., Naschle, W., Vogel, W. Percutaneous management of a hepatic artery aneurysm: bleeding after liver transplantation. Cardiovasc. Intervent Radiol., 2004 Sep-Oct; 27(5): 525–528.

12. Harman, A., Boyvat, F., Hasdogan, B., Aytekin, C., Karakayali, H., Haberal, M. Endovascular treatment of active bleeding after liver transplant. Exp. Clin. Transplant., 2007 Jun; 5(1): 596–600.

13. Ko, H. S., Anders, M., Diehl, S., Dominguez, E., Löhr, M., Düber, C. Portal vein erosion and acute abdominal hemorrhagie as a complication of acute pankreatitis. Abdominal Imaging, 2003; 28: 700–702.

14. Takayama, T., Kato, K., Sano, H., et al. Spontaneous rupture of a pancreatic pseudocyst into the portal venous systém. AJR 1986; 147: 935–936.

15. Takayama, T., Kato, K., Katada, N., et al. Radiological demonstration of spontaneous rupture of a pancreatic pseudocyst into the portal systém. Am. J. Gastroenterol., 1982; 76: 55–58.

16. Procacci, C., Mansueto, G. C., Graziani, R., et al. Spontaneous rupture of a pancreatic pseudocyst into the portal vein. Cardiovasc. Intervent Radiol., 1995; 18: 399–402.

17. Packeisen, J., Klingen, D., Grezella, F. Spontaneous rupture of a pancreatic pseudocyst into the portal vein. Z. Gastroenterol., 2001; 39: 961–964.

18. Skarsgard, E. D., Ellison, E., Quenville, N. Spontaneous rupture of a pancreatic pseudocyst into the portal vein. Can. J. Surg., 1995; 38: 459–463.

19. Willis, S. M., Brewer, T. G. Pancreatico-portal vein fistula. Gastroenterology, 1989; 97: 1025–1027.

20. van Steenberg, W., Ponette, E. Pancreatico-portal fistula: a rare complication of chronic pancreatitis. Gastrointest. Radiol., 1990; 15: 299–300.

21. Krajina, A., Hulek, P., Ferko, A., Nozicka, J. Extrahepatic portal venous laceration in TIPS treated with stent graft placement. Hepatogastroenterology, 1997 May-Jun; 44(15): 667–670.

22. Brountzos, E. N., Efthymia, A., Koskinas, I., Thanos, L., Papathanasiou, M. A., Kelekis, D. A. Intraperitoneal portal vein bleeding dutiny transjugular intrahepatic portosystemic shunt: Treatment with stent-graft placement. AJR, 2000; 174: 132–134.