Hemorrhage complicating the course of severe acute pancreatitis

Vikas Gupta; Pradeep Krishna; Rakesh Kochhar; Thakur Deen Yadav; Venu Bargav; Asheesh Bhalla; Naveen Kalra; Jai Dev Wig

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자료유형: 학술저널

저자정보: Vikas Gupta (Postgraduate Institute of Medical Education and Research) Pradeep Krishna (Postgraduate Institute of Medical Education and Research) Rakesh Kochhar (Postgraduate Institute of Medical Education and Research) Thakur Deen Yadav (Postgraduate Institute of Medical Education and Research) Venu Bargav (Postgraduate Institute of Medical Education and Research) Asheesh Bhalla (Postgraduate Institute of Medical Education and Research) Naveen Kalra (Postgraduate Institute of Medical Education and Research) Jai Dev Wig (Postgraduate Institute of Medical Education and Research)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제24권 제3호

발행연도: 2020.8

수록면: 292 - 300 (9page)

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Backgrounds/Aims: The course of severe acute pancreatitis (SAP) complicated by hemorrhage is associated with poor outcome. Methods: Twenty-four (13%) out of 183 cases of SAP had hemorrhagic complications- 12 intraabdominal & 12 intraluminal, 13 had major & 11 had minor and 16 had de-novo & 8 post-surgical bleeding. The mean duration of pancreatitis prior to bleeding was 27±27.2 days. Results: Predictors of haemorrhage on univariate analysis were delayed admission (0.037), more than one organ failure (p=0.008), presence of venous thrombosis (p=0.033), infective necrosis (0.001) and systemic sepsis – bacterial (0.037) & fungal (p=0.032). On multivariate analysis infected necrosis (OR=11.82) and presence of fungal sepsis (OR=3.73) were the significant factors. Patients presenting with more than one organ failure and bacterial sepsis had borderline significance on multivariate analysis. Need for surgery (50% vs. 12.6%), intensive care stay (7.4±7.9 vs. 5.4±5.2 days) and mortality (41.7% vs. 10.7%) were significantly higher in patients who suffered haemorrhage. Seven of the 13 with major bleeding had pseudoaneurysms-4 were embolized, 4 needed surgery including 1 embolization failure. Seven with intraabdominal bleeding required surgical intervention, 2 had successful embolization and 3 had expectant management. CT severity index and surgical intervention, were significantly associated with intraabdominal bleeding. Organ failure, presence of pseudoaneurysm and surgical intervention were associated with major bleeding. Conclusions: Hemorrhage in SAP was associated with increased morbidity and mortality. Infected necrosis accentuated the degradation of the vessel wall, which predispose to hemorrhage. Luminal bleeding may be indicative of erosion into the adjacent viscera by the pseudoaneurysm.

#Haemorrhage #Pancreatitis #Bleeding #Complication #Acute #Abdominal #Pseudoaneurysm

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Vikas GUPTA

소속기관 TATA Memorial Hospital

주요연구분야 의약학 > 임상의학 > 일반 외과학

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Pradeep Krishna