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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2017; 23(30): 5460-5468
Published online Aug 14, 2017. doi: 10.3748/wjg.v23.i30.5460
Pancreatitis: Preventing catastrophic haemorrhage
Richard PT Evans, Moustafa Mabrouk Mourad, Gunraj Pall, Simon G Fisher, Simon R Bramhall
Richard PT Evans, Gunraj Pall, Russel’s Hall Hospital, Dudley DY1 2HQ, United Kingdom
Moustafa Mabrouk Mourad, Simon G Fisher, Simon R Bramhall, Department of Surgery, the Wye Valley NHS Trust, Hereford HR1 2ER, United Kingdom
Author contributions: Evans RPT designed the study; Evans RPT, Mourad MM and Pall G collected, analysed, interpreted the data, and drafted the article; Fisher SG and Bramhall SR designed the conception, critically revised the manuscript for important intellectual content, and made the final approval of the version to be published.
Conflict-of-interest statement: None of the authors has any potential conflicting financial interests relevant to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Simon R Bramhall, Department of Surgery, the Wye Valley NHS Trust, Stonebow Rd, Hereford HR1 2ER, United Kingdom. simon.bramhall@wvt.nhs.uk
Telephone: +44-7976-278549 Fax: + 44-1432-364102
Received: March 14, 2017
Peer-review started: March 18, 2017
First decision: April 5, 2017
Revised: May 3, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: August 14, 2017
Processing time: 152 Days and 10.1 Hours
Abstract

Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.

Keywords: Complication of pancreatitis; Splenicartery; Pancreatitis; Haemorrhage; Pseudoaneurysm

Core tip: Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals. The presence of a fluid collection, necrosis and infection can directly contribute to such vascular complications which are associated with a significant morbidity and mortality. Early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.