What pancreatic diseases cause intractable hemorrhage?

From the Guidelines

Pancreatic diseases that can cause intractable hemorrhage include severe acute necrotizing pancreatitis, pancreatic pseudoaneurysms, and pancreatic cancer, with severe acute necrotizing pancreatitis being a leading cause of massive bleeding due to erosion of surrounding blood vessels 1.

Causes of Intractable Hemorrhage

• Severe acute necrotizing pancreatitis: can lead to erosion of blood vessels surrounding the pancreas, resulting in massive bleeding that may be difficult to control 1
• Pancreatic pseudoaneurysms: form when pancreatic enzymes digest arterial walls, creating weakened areas that can rupture and cause life-threatening hemorrhage
• Pancreatic cancer: may invade major blood vessels, leading to severe bleeding that cannot be effectively managed

Treatment and Management

Treatment typically involves immediate resuscitation with fluid and blood products, followed by interventional radiology procedures such as angiographic embolization or, in some cases, emergency surgery 1. However, the deep retroperitoneal location of the pancreas and the digestive nature of pancreatic enzymes can make hemorrhage from these conditions particularly difficult to access and control, sometimes resulting in untreatable bleeding despite medical intervention.

Key Considerations

• The pancreas is situated near major blood vessels including the splenic artery, gastroduodenal artery, and portal venous system, making hemorrhage from pancreatic diseases particularly dangerous 1
• Interventions for necrotizing pancreatitis should preferably be done when the necrosis has become walled-off, usually after 4 weeks after the onset of the disease 1

From the FDA Drug Label

Pancreatitis was also observed Pancreatitis, which have sometimes required cholecystectomy A few patients developed acute cholecystitis, ascending cholangitis, biliary obstruction, cholestatic hepatitis, or pancreatitis during octreotide acetate injection therapy or following its withdrawal.

Pancreatic diseases that may cause intractable hemorrhage include:

• Pancreatitis 2, 2, 2

From the Research

Pancreatic Diseases Causing Intractable Hemorrhage

• Pancreatic pseudocysts are a common cause of intractable hemorrhage, particularly in patients with chronic pancreatitis 3, 4, 5, 6
• Chronic pancreatitis is a significant risk factor for developing pancreatic pseudocysts and subsequent hemorrhage 3, 4, 5, 7
• Acute pancreatitis can also lead to hemorrhagic complications, including bleeding pseudoaneurysms and diffuse bleeding with pancreatic necrosis 7, 6
• Pancreatic cancer is another underlying pancreatic disease that can cause severe hemorrhage 7

Types of Hemorrhage

• Intracystic hemorrhage from a pseudoaneurysm is a rare but potentially lethal complication of pancreatic pseudocysts 3
• Bleeding pseudoaneurysms are a common cause of hemorrhage in patients with pancreatitis 5, 6
• Diffuse bleeding with pancreatic necrosis is another type of hemorrhage that can occur in patients with pancreatitis 6
• Hemorrhagic pseudocysts can also cause intractable hemorrhage 3, 6

Diagnostic and Treatment Options

• Diagnostic modalities used to diagnose hemorrhagic pseudocysts include ultrasound with color doppler, CT with contrast, digital subtraction angiography, and angiography 3
• Angiographic embolization of the culprit artery is a preferred treatment option for pseudoaneurysms 3
• Transcatheter arterial embolization (TAE) is increasingly used as the first-line treatment for hemorrhage complicating pancreatitis and post-pancreatectomy 7
• Surgery, including distal pancreatectomy and splenectomy, may be necessary in some cases 4, 5, 7