Document Detail

Hemorrhage in acute pancreatitis: should gastrointestinal bleeding be considered an organ failure?
MedLine Citation:
PMID:  18376304     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To define the magnitude, causes, risk factors, and consequences of hemorrhage in acute pancreatitis (AP). METHODS: Consecutive patients with AP were studied for hemorrhagic complication and its impact on mortality. Patients with gastrointestinal (GI) hemorrhage or hemorrhage within the pancreatic bed were managed with transfusions, endotherapy, angiographic embolization, or surgery as appropriate. RESULTS: Of 449 patients, 28 (6.2%) developed hemorrhage. The mean age of patients with hemorrhage was 39 +/- 14 years and 25 (89%) were men. Of the 28 patients, 16 had GI hemorrhage, and 12 had hemorrhage into the pancreatic bed. Median interval between the onset of AP and hemorrhage was 26.5 days. Pancreatic necrosis, sepsis, fluid collection, and organ failure were found to be risk factors for hemorrhage. Five patients had pseudoaneurysms; angiographic embolization was successful in 4 of them. The mortality rate in bleeders was higher than that in nonbleeders (28.6% vs 13%; P = 0.02). None of the patients died as a direct consequence of hemorrhage except 1 patient who died after surgery for failed embolization of bleeding pseudoaneurysm. Deaths were mainly caused by sepsis and multiorgan failure. CONCLUSIONS: Hemorrhagic complications are usually late manifestations in the course of severe pancreatitis and per se have little bearing on mortality.
Praveen Kumar Sharma; Kaushal Madan; Pramod Kumar Garg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pancreas     Volume:  36     ISSN:  1536-4828     ISO Abbreviation:  Pancreas     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-06-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  United States    
Other Details:
Languages:  eng     Pagination:  141-5     Citation Subset:  IM    
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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MeSH Terms
Acute Disease
Disease Progression
Gastrointestinal Hemorrhage / etiology*,  mortality,  pathology,  therapy
Hemorrhage / etiology*,  mortality,  pathology,  therapy
Middle Aged
Multiple Organ Failure / etiology*,  mortality,  pathology,  therapy
Pancreatic Diseases / etiology*,  mortality,  pathology,  therapy
Pancreatitis / complications*,  mortality,  pathology,  therapy
Prospective Studies
Risk Factors
Sepsis / complications
Severity of Illness Index

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