The risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Ling , LU Shan , LU Huimin ,  HU Weiming

Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

HU Weiming, Email: huweiming@scu.edu.cn

Keywords：

severe acute pancreatitis; intra-abdominal bleeding; risk factor

DOI：

10.7507/1007-9424.201712026

Video：

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Objective To summarize the risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis. Methods A retrospective review was conducted of 347 patients underwent necrosectomy for severe acute pancreatitis between January 2011 and December 2015 at West China Hospital of Sichuan University. Results Of the 347 patients, thirty-eight patients had intra-abdominal bleeding after surgeries, including 5 patients who had twice bleeding. The bleeding positions including splenic vein (n=7), splenic artery (n=2), pancreatic and peripancreatic vessels (n=8), colonic mesangial vessels (n=6), other vessels (n=12), and extensive osmotic bleeding in abdominal cavity (n=7). Hemostatic modes: suture (n=20), compression hemostasis (n=18), transcatheteranerial embolism (n=2), suture and compression hemostasis (n=4), and conservative treatment (n=1). There were 19 dead patients of 38 bleeding patients. There were statistically significant differences between the hemorrhage group and the non-hemorrhage group on gender, acute physiology and chronic health evaluation (APACHEⅡ) scores and modified Marshall scores at admission, interval onset to surgery, surgical approaches, and morbidity (P<0.05). Compared with the non-hemorrhage group, there were more males, higher APACHE Ⅱ scores and modified Marshall scores, longer interval onset to surgery, and higher mortality in the hemorrhage group. Multivariable logistic regression analysis showed that male patients had higher risk of intra-abdominal bleeding (OR=3.980, P=0.004), as the grow of APACHEⅡ scores, the risk of intra-abdominal bleeding increased (OR=1.487, P<0.001). Conclusions We should pay more attention on the male SAP patients as well as patients with multiple organ dysfunction.

Citation： ZHANG Ling, LU Shan, LU Huimin, HU Weiming. The risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(5): 565-571. doi: 10.7507/1007-9424.201712026 Copy

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2.	Bendersky VA, Mallipeddi MK, Perez A, et al. Necrotizing pancreatitis: challenges and solutions. Clin Exp Gastroenterol, 2016, 9: 345-350.
3.	朱峰, 秦仁义. 重症急性胰腺炎合并腹腔出血的早期诊断及处理方式. 中国实用外科杂志, 2012, 32(7): 554-556.
4.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis－2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
5.	Muckart DJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med, 1997, 25(11): 1789-1795.
6.	Mamlouk MD, van Sonnenberg E. Interventional radiology for necrotizing pancreatitis. J Gastrointest Surg, 2011, 15(7): 1101-1103.
7.	Werge M, Novovic S, Schmidt PN, et al. Infection increases mortality in necrotizing pancreatitis: a systematic review and meta-analysis. Pancreatology, 2016, 16(5): 698-707.
8.	Flati G, Andrén-Sandberg A, La Pinta M, et al. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas, 2003, 26(1): 8-14.
9.	Mukherjee R, Mareninova OA, Odinokova IV, et al. Mechanism of mitochondrial permeability transition pore induction and damage in the pancreas: inhibition prevents acute pancreatitis by protecting production of ATP. Gut, 2016, 65(8): 1333-1346.
10.	Peng T, Peng X, Huang M, et al. Serum calcium as an indicator of persistent organ failure in acute pancreatitis. Am J Emerg Med, 2017, 35(7): 978-982.
11.	Wang L, Liu GJ, Chen YX, et al. Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion. Med PrincPract, 2012, 21(1): 20-23.
12.	Fernandes A, Almeida N, Ferreira AM, et al. Left-sided portal hypertension: a sinister entity. GE Port J Gastroenterol, 2015, 22(6): 234-239.
13.	唐诗彬, 张肇达, 李全生, 等. 重症急性胰腺炎术后腹腔大出血(附 13 例分析). 中华肝胆外科杂志, 2003, 9(3): 185-186.
14.	Wei AL, Guo Q, Wang MJ, et al. Early complications after interventions in patients with acute pancreatitis. World J Gastroenterol, 2016, 22(9): 2828-2836.
15.	Thandassery RB, Yadav TD, Dutta U, et al. Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure. HPB (Oxford), 2013, 15(7): 523-528.
16.	Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg, 2014, 259(6): 1201-1207.
17.	赵世峰, 沈洪. 重症急性胰腺炎致急性呼吸窘迫综合征的临床研究. 中国急救医学, 2005, 25(4): 240, 241-242.
18.	高伟, 崔乃强. 重症急性胰腺炎器官损害的临床特征及治疗. 中国实验方剂学杂志, 2011, 17(10): 253-256.
19.	Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med, 2013, 39(7): 1190-1206.
20.	邹宇, 孙备. 重症急性胰腺炎术后并发症的预防及处理. 国际外科学杂志, 2016, 43(4): 282-285.
21.	李全生, 刘续宝, 张肇达. 重症急性胰腺炎术后出血 6 例报告. 中国实用外科杂志, 2000, 20(5): 293-294.
22.	Nykänen T, Udd M, Peltola EK, et al. Bleeding pancreatic pseudoaneurysms: management by angioembolization combined with therapeutic endoscopy. Surg Endosc, 2017, 31(2): 692-703.
23.	Zhou F, Wang C, Xiong J, et al. Experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis by TAE. J HuazhongUniv Sci Technolog Med Sci, 2005, 25(2): 182-184.
24.	Guo Q, Li A, Xia Q, et al. Timing of intervention in necrotizing pancreatitis. J Gastrointest Surg, 2014, 18(10): 1770-1776.
25.	van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.

1. Boumitri C, Brown E, Kahaleh M. Necrotizing pancreatitis: current management and therapies. Clin Endosc, 2017, 50(4): 357-365.
2. Bendersky VA, Mallipeddi MK, Perez A, et al. Necrotizing pancreatitis: challenges and solutions. Clin Exp Gastroenterol, 2016, 9: 345-350.
3. 朱峰, 秦仁义. 重症急性胰腺炎合并腹腔出血的早期诊断及处理方式. 中国实用外科杂志, 2012, 32(7): 554-556.
4. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis－2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
5. Muckart DJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med, 1997, 25(11): 1789-1795.
6. Mamlouk MD, van Sonnenberg E. Interventional radiology for necrotizing pancreatitis. J Gastrointest Surg, 2011, 15(7): 1101-1103.
7. Werge M, Novovic S, Schmidt PN, et al. Infection increases mortality in necrotizing pancreatitis: a systematic review and meta-analysis. Pancreatology, 2016, 16(5): 698-707.
8. Flati G, Andrén-Sandberg A, La Pinta M, et al. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas, 2003, 26(1): 8-14.
9. Mukherjee R, Mareninova OA, Odinokova IV, et al. Mechanism of mitochondrial permeability transition pore induction and damage in the pancreas: inhibition prevents acute pancreatitis by protecting production of ATP. Gut, 2016, 65(8): 1333-1346.
10. Peng T, Peng X, Huang M, et al. Serum calcium as an indicator of persistent organ failure in acute pancreatitis. Am J Emerg Med, 2017, 35(7): 978-982.
11. Wang L, Liu GJ, Chen YX, et al. Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion. Med PrincPract, 2012, 21(1): 20-23.
12. Fernandes A, Almeida N, Ferreira AM, et al. Left-sided portal hypertension: a sinister entity. GE Port J Gastroenterol, 2015, 22(6): 234-239.
13. 唐诗彬, 张肇达, 李全生, 等. 重症急性胰腺炎术后腹腔大出血(附 13 例分析). 中华肝胆外科杂志, 2003, 9(3): 185-186.
14. Wei AL, Guo Q, Wang MJ, et al. Early complications after interventions in patients with acute pancreatitis. World J Gastroenterol, 2016, 22(9): 2828-2836.
15. Thandassery RB, Yadav TD, Dutta U, et al. Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure. HPB (Oxford), 2013, 15(7): 523-528.
16. Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg, 2014, 259(6): 1201-1207.
17. 赵世峰, 沈洪. 重症急性胰腺炎致急性呼吸窘迫综合征的临床研究. 中国急救医学, 2005, 25(4): 240, 241-242.
18. 高伟, 崔乃强. 重症急性胰腺炎器官损害的临床特征及治疗. 中国实验方剂学杂志, 2011, 17(10): 253-256.
19. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med, 2013, 39(7): 1190-1206.
20. 邹宇, 孙备. 重症急性胰腺炎术后并发症的预防及处理. 国际外科学杂志, 2016, 43(4): 282-285.
21. 李全生, 刘续宝, 张肇达. 重症急性胰腺炎术后出血 6 例报告. 中国实用外科杂志, 2000, 20(5): 293-294.
22. Nykänen T, Udd M, Peltola EK, et al. Bleeding pancreatic pseudoaneurysms: management by angioembolization combined with therapeutic endoscopy. Surg Endosc, 2017, 31(2): 692-703.
23. Zhou F, Wang C, Xiong J, et al. Experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis by TAE. J HuazhongUniv Sci Technolog Med Sci, 2005, 25(2): 182-184.
24. Guo Q, Li A, Xia Q, et al. Timing of intervention in necrotizing pancreatitis. J Gastrointest Surg, 2014, 18(10): 1770-1776.
25. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis

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