Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis
L. P. Gambiez, O. J. Ernst, O. A. Merlier, H. L. Porte, J. P. Chambon and P. A. Quandalle
Clinique Chirurgicale Ouest, Hopital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, France.
OBJECTIVES: To evaluate the efficacy of arterial embolization (EMB) in the
management of bleeding pancreatic pseudocysts or pseudoaneurysms and to
assess the possible indication for secondary surgery. DESIGN: Retrospective
review with a mean follow-up of 60 months (range, 18-125 months). SETTING:
Tertiary care center, university hospital. PATIENTS: The medical records of
14 patients who were referred to the hospital with bleeding pancreatic
pseudocysts and/or pseudoaneurysms related to chronic pancreatitis, between
1983 and 1994, were reviewed. The clinical presentation was major bleeding
in 10 patients (gastrointestinal or intraperitoneal) and chronic signs in
4. INTERVENTION: Celiac and superior mesenteric angiography with EMB
attempt in all patients. MAIN OUTCOME MEASURES: The immediate effect on
bleeding and the long-term safety of arterial EMB. RESULTS: Embolization
failed in 3 patients and surgery was needed (1 patient died). Embolization
was successful in 11 patients, but 2 complications occurred (duodenal
necrosis and aortic thrombosis) (1 patient died). Among the 10 patients
whose bleeding stopped, an intentional pancreatectomy was performed 4 times
(all patients are alive). The 6 other patients did not undergo a further
pancreatic operation due to unfavorable local or general condition. None of
them had recurrent bleeding, 3 of them died later of extrapancreatic
diseases. Overall, early mortality was 14%, with deaths occurring only in
unsuccessful or complicated EMB cases. CONCLUSIONS: The immediate
effectiveness of arterial EMB is undeniable but depends on the expertise of
the radiologist. When EMB is successful, further surgery should be reserved
for patients in good general condition who have other complications of
chronic pancreatitis that are not amenable to minimally invasive
techniques.
