Evidence for a central role for selective mesenteric angiography in the management of the major vascular complications of pancreatitis

Am J Surg. 2003 Feb;185(2):96-102. doi: 10.1016/s0002-9610(02)01199-6.


Background: Although mesenteric angiography and embolization are established radiologic procedures, the evidence-base to aid decision making regarding selection of these procedures in the emergent situation in patients with hemorrhagic complications of pancreatitis is limited.

Methods: A retrospective analysis of 19 patients with hemorrhagic complications of pancreatic inflammatory disease (acute pancreatitis, chronic pancreatitis, and pseudocyst) referred over a 4-year period and identified at the point of mesenteric angiography in order to determine the influence of interventional radiologic maneuvers on outcome.

Results: Mesenteric angiography localized bleeding in 15 (79%), with 11 (58%) embolizations undertaken. There was one (9%) procedure-related complication and 3 (27%) rebleeds. Of 11 patients undergoing embolization, 8 (73%) required no further intervention for bleeding and 8 (73%) survived.

Conclusions: Mesenteric angiography is valuable in localizing bleeding in patients with major vascular complications of pancreatic inflammatory disease. Angiographic embolization can achieve definitive hemostasis and stabilize a critically ill patient to permit disease reappraisal.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, False / etiology
  • Aneurysm, False / therapy
  • Angiography / methods
  • Embolization, Therapeutic*
  • Evidence-Based Medicine*
  • Female
  • Hemorrhage / etiology
  • Hemorrhage / therapy*
  • Humans
  • Male
  • Mesentery / blood supply
  • Mesentery / diagnostic imaging*
  • Middle Aged
  • Pancreatic Pseudocyst / complications*
  • Pancreatitis / complications*
  • Retrospective Studies
  • Software Design
  • Treatment Outcome