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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(03): 294-300
DOI: 10.1055/s-0041-1739376
Original Article

Can Empirical Segmental Angioembolization of Splenic Artery Salvage Pancreatic Intraluminal Bleed?

Autor*innen

  • Sreekumar Sreejith 

    1   Department of Surgical Gastroenterology, Medical College Hospital, Trivandrum, Kerala, India

  • Ramesh Rajan 

    1   Department of Surgical Gastroenterology, Medical College Hospital, Trivandrum, Kerala, India

  • Bonny Natesan

    1   Department of Surgical Gastroenterology, Medical College Hospital, Trivandrum, Kerala, India

  • Sindhu RS

    1   Department of Surgical Gastroenterology, Medical College Hospital, Trivandrum, Kerala, India

  • V. Jineesh 

    2   Department of Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

  • E. R. Jayadevan

    2   Department of Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Abstract

Background Postpancreatectomy hemorrhage (PPH) and Hemosuccus Pancreaticus (HP) may present with slow but significant intraluminal bleed which may not be evident on imaging. We evaluated the efficacy of empirical segmental-angioembolization of splenic artery in intraluminal PPH and HP.

Result This is a cross-sectional study done by analyzing all consecutive patients with PPH and HP who underwent empirical coil embolization of splenic artery. There were total of 137 pancreaticoduodenectomies (PD), 68 distal pancreatectomies (DP), 11 patients with median pancreatectomies (MP) and 134 admissions for acute pancreatitis and exacerbation of chronic pancreatitis during the study period. Eleven (5.1%) patients had PPH, of which two were managed surgically. Among nine patients, 4/9 (44.4%) with pseudoaneurysm on computed tomography angiography (CTA) were excluded. Among pancreatitis, 7 (5.2%) had HP, and 5/7 (71.4%) patients with pseudoaneurysm on CTA were excluded. Hence, seven patients, PPH—5 and HP—2, were included. Both HP patients were managed successfully with empirical segmental coil embolization of splenic artery. Among PPH, one patient required laparotomy for failed embolization. Overall, 6/7 (85.7%) had successful coil embolization. No reintervention, continued bleed, or blood transfusions were required postprocedure, and no splenic infarct or abscess was seen in any of the seven patients postembolization. The 72-hour rebleed rate was 1/7 (14.3%), which was managed surgically.

Conclusion Empirical segmental coil embolization of splenic artery in intraluminal pancreatic bleed holds promise as a salvage life-saving procedure even when no blush or pseudoaneurysm is evident.

Keywords

Empirical Coil Embolization - Pancreatectomy - Post Pancreatectomy Hemorrhage - Splenic Artery Pseudoaneurysm

Grants and Financial support

This project did not receive any grants and financial support.


Author Contributions

R.R. outlined concept and gave guidance for study. Data analysis and interpretation were done by B.N. and R.S.S. V.J. and E.R.J. did IR procedure and interpretation of data. S.S. acquired data and drafted manuscript. Critical editing was done by R.R.




Publikationsverlauf

Artikel online veröffentlicht:
31. Juli 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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