Hemorrhagic Complications of Pancreatitis

Bleeding in pancreatitis may be due either to gastroduodenal causes (e.g., acute gastric erosions, mucosal congestions, peptic ulceration, Mallory-Weiss syndrome, and alcoholic gastritis), which are usually managed with conservative treatment [1], or to direct involvement of vascular structures by pancreatitic local sequelae. The latter, although uncommon, is usually characterized by massive hemorrhage, which is considered the most severe and rapidly lethal complication of pancreatitis [2, 3]. It may be associated with either acute or chronic pancreatitis and is caused by major vessels’ erosion, followed in most cases by vessel disruption or pseudoaneurysm formation. Pseudocysts, severe inflammation, regional necrosis, and infection are the most important pathogenetic factors [4, 5]. Although the incidence of major bleeding in pancreatitis is relatively low (1.7%–2.5%), it is associated with a prohibitively high mortality rate reaching 40%–80% [6, 7, 8].