Subject(s)
Aneurysm, False/therapy , Cholecystectomy, Laparoscopic/adverse effects , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/therapy , Hepatic Artery/diagnostic imaging , Aneurysm, False/diagnostic imaging , Angiography/methods , Cholecystectomy, Laparoscopic/methods , Cholelithiasis/diagnosis , Cholelithiasis/surgery , Embolization, Therapeutic/instrumentation , Emergency Service, Hospital , Endovascular Procedures/methods , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/physiopathology , Hematemesis/diagnosis , Hematemesis/etiology , Humans , Rare Diseases , Risk Assessment , Severity of Illness Index , Stents , Tomography, X-Ray Computed/methods , Treatment Outcome , Young AdultABSTRACT
AIM AND BACKGROUND: Delayed hemorrhage after pancreaticoduodenectomy (PD) is still one of the most common causes of mortality. However, the case series regarding interventional treatment of delayed hemorrhage after PD are limited. In this retrospective study, we aimed to evaluate functional outcomes of interventional treatment of late hemorrhages developing after PD. MATERIAL AND METHODS: We retrospectively evaluated 16 patients who received endovascular treatment for delayed arterial hemorrhage after PD procedure. Postsurgical nonhemorrhagic complications, time of hemorrhage, site of hemorrhage, endovascular treatment technique, postprocedural complications, and mortality rates were obtained. RESULTS: Mean duration of delayed hemorrhage after PD was 18 days. Computed tomography angiography images for the hemorrhage period were available for 15 patients. We observed extravasation alone in seven patients and pseudoaneurysm alone in five. Pushable coil was used in 15 patients and covered stent in 1. Two patients died due to hepatic failure, and one patient died because of multiple organ dysfunction syndrome (MODS). CONCLUSIONS: Delayed hemorrhage after PD is difficult to identify, but accurate and early diagnosis is of vital importance. To date, most appropriate management of this complication remains unclear. Although endovascular treatment techniques may vary for every patient, it is a reliable and effective method for halting hemorrhage. Therefore, interventional procedures must be primarily considered rather than surgical interventions.
Subject(s)
Embolization, Therapeutic , Pancreaticoduodenectomy/adverse effects , Postoperative Hemorrhage/therapy , Stents , Adult , Aged , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/therapy , Angiography , Angiography, Digital Subtraction , Female , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Multidetector Computed Tomography , Postoperative Hemorrhage/diagnostic imaging , Postoperative Hemorrhage/etiology , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: Severe acute pancreatitis usually requires intensive management of cardiovascular, pulmonary, renal, and septic complications. Many scoring systems are used in determining the outcomes. The aim of the study was to evaluate the role of three scoring systems, i.e. Acute Physiology and Chronic Health Evaluation, Sequential Organ Failure Assessment, and modified Ranson's criteria, in predicting mortality rate in patients with severe acute pancreatitis as well as other factors influencingmortality in patients admitted to intensive care unit. MATERIALS AND METHODS: Charts of 43 patients hospitalized in intensive care unit with severe acute pancreatitis were screened retrospectively. Four patients were excluded. Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment and modified Ranson's scores were calculated on admission, and Sequential Organ Failure Assessment score was recorded on weekly intervals during the intensive care unit stay. RESULTS: Thirty-nine patients were included in the study (65% male, mean age: 61 years). The intensive care unit mortality was 64% and hospital mortality was 71%. Sequential Organ Failure Assessment scores correlated significantly with mortality. All patients with Sequential Organ Failure Assessment score ≥11 at any time during intensive care unit stay had higher mortality (80% sensitivity, 79% specificity, ROC=0,837). Although Acute Physiology and Chronic Health Evaluation II is used to estimate mortality prognosis, we could not find any statistically significant association between Acute Physiology and Chronic Health Evaluation II scores and mortality. CONCLUSION: Various scoring systems are used to determine the prognosis of severe acute pancreatitis. In this group of patients, higher Sequential Organ Failure Assessment scores predict higher intensive care unit/hospital mortality.