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

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%) procedurerelated 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. (C) 2003 Excerpta Medica Inc. All rights reserved.