From the Research
The most common cause of massive bleeding in chronic pancreatitis is pseudoaneurysm (option a). Pseudoaneurysms develop when pancreatic enzymes leak and erode into adjacent arterial walls, creating a contained rupture that can eventually bleed massively. This occurs because chronic inflammation in pancreatitis leads to the release of digestive enzymes that can damage surrounding blood vessels. The splenic artery is most commonly affected, followed by the gastroduodenal and pancreaticoduodenal arteries. These pseudoaneurysms may remain silent until they rupture, causing life-threatening hemorrhage into the pancreatic duct, peritoneal cavity, or retroperitoneum. Patients typically present with sudden abdominal pain, hemodynamic instability, and gastrointestinal bleeding. Management usually involves urgent angiography with embolization or surgical intervention, as suggested by 1. Unlike the other options, pseudoaneurysms have a direct pathophysiological relationship with the enzymatic activity and chronic inflammatory process characteristic of chronic pancreatitis. Some key points to consider in the management of pseudoaneurysms in chronic pancreatitis include:
- Urgent angiography to localize the bleeding site
- Embolization as a first-line treatment to stop the bleeding
- Surgical intervention for patients who are hemodynamically unstable or have failed embolization, as recommended by 2
- The importance of considering the location of the pseudoaneurysm, with resection being a preferential procedure for lesions located over the tail of the pancreas, as noted in 1. Overall, pseudoaneurysms are a serious and potentially life-threatening complication of chronic pancreatitis, and prompt recognition and treatment are essential to improve outcomes.