Endovascular embolization of arterial bleeding in patients with severe acute pancreatitis

Giant Hemorrhagic Pancreatic Pseudocyst: A Case Report and Guidelines for Care

Pancreatic pseudocysts are potential sequelae of acute or chronic pancreatitis. In some cases, enzymatic degradation of the lining between a pseudocyst and the splenic artery, or surrounding vessels, can occur, resulting in a hemorrhagic pancreatic pseudocyst. Very few of these hemorrhagic pseudocysts meet the criteria for giant pseudocysts. We discuss the case of a 30-year-old male patient with a history of alcohol abuse who presented to the hospital with a giant hemorrhagic pancreatic pseudocyst; he was admitted for expectant management and was subsequently discharged. This case report seeks to shed light on the dearth of similar cases.

InterNet: Detection of Active Abdominal Arterial Bleeding Using Emergency Digital Subtraction Angiography Imaging With Two-Stage Deep Learning

Objective

Active abdominal arterial bleeding is an emergency medical condition. Herein, we present our use of this two-stage InterNet model for detection of active abdominal arterial bleeding using emergency DSA imaging.

Methods

Firstly, 450 patients who underwent abdominal DSA procedures were randomly selected for development of the region localization stage (RLS). Secondly, 160 consecutive patients with active abdominal arterial bleeding were included for development of the bleeding site detection stage (BSDS) and InterNet (cascade network of RLS and BSDS). Another 50 patients that ruled out active abdominal arterial bleeding were used as negative samples to evaluate InterNet performance. We evaluated the mode's efficacy using the precision-recall (PR) curve. The classification performance of a doctor with and without InterNet was evaluated using a receiver operating characteristic (ROC) curve analysis.

Results

The AP, precision, and recall of the RLS were 0.99, 0.95, and 0.99 in the validation dataset, respectively. Our InterNet reached a recall of 0.7, the precision for detection of bleeding sites was 53% in the evaluation set. The AUCs of doctors with and without InterNet were 0.803 and 0.759, respectively. In addition, the doctor with InterNet assistant could significantly reduce the elapsed time for the interpretation of each DSA sequence from 84.88 to 43.78 s.

Conclusion

Our InterNet system could assist interventional radiologists in identifying bleeding foci quickly and may improve the workflow of the DSA operation to a more real-time procedure.

Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries

PURPOSE

The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries.

MATERIALS AND METHODS

Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann-Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors.

RESULTS

TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025).

CONCLUSION

TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.

Abdominal rebleeding after transcatheter arterial embolization for ruptured pseudoaneurysms associated with severe acute pancreatitis: a retrospective study

Introduction

Patients are at risk of abdominal rebleeding after transcatheter arterial embolization (TAE) for pancreatitis-related pseudoaneurysm, which increases the mortality rate.

Aim

This study was performed to evaluate the effects of an intestinal fistula (IF) and the anatomical location of the pseudoaneurysm on abdominal rebleeding after TAE of a ruptured pseudoaneurysm associated with severe acute pancreatitis (SAP).

Material and methods

From February 2013 to November 2019, 24 patients with SAP-related pseudoaneurysm rupture and hemorrhage in our hospital underwent TAE. All patients’ epidemiological data and related medical histories were collected and statistically analyzed. We classified the pseudoaneurysms as type I, II, and III according to their anatomical locations and as type A (without an IF) and type B (with an IF).

Results

The interventions for abdominal infection in patients with type I pseudoaneurysms were percutaneous drainage in 6 patients, endoscopic necrotic tissue removal in 5, and surgical necrotic tissue removal or enterostomy in none, with a rebleeding rate of 33.3% (3/9 patients). The interventions for abdominal infection in patients with type II pseudoaneurysms were percutaneous drainage in 7 patients, endoscopy in three, and surgery in one, with a rebleeding rate of 20.0% (2/10 patients). The interventions for abdominal infection in patients with type III pseudoaneurysms were percutaneous drainage in 3 patients, endoscopy in 1, and surgery in 2, with a rebleeding rate of 80.0% (4/5 patients). There was no statistically significant difference in the types of interventions for abdominal infection among patients with type I, II, and III pseudoaneurysms (p = 0.355) or in the rate of abdominal rebleeding after TAE for type III pseudoaneurysms (p = 0.111). The interventions for abdominal infection in patients with type A pseudoaneurysms were percutaneous drainage in 13 patients, endoscopy in 6, and surgery in 1, with a rebleeding rate of 22.2% (4/18 patients) and mortality rate of 11.1% (2/18 patients). The interventions for abdominal infection in patients with type B pseudoaneurysms were percutaneous drainage in 3 patients, endoscopy in 3, and surgery in 2, with a rebleeding rate of 83.3% (5/6 patients) and mortality rate of 66.7% (4/6 patients). There was no significant difference in the types of interventions for abdominal infection in patients with and without IF (p = 0.215); however, the rebleeding rate and mortality rate were significantly higher in patients with IF (p = 0.015 and 0.018, respectively).

Conclusions

IF may increase the rate of abdominal rebleeding after TAE for ruptured SAP-related pseudoaneurysms, while the anatomical location of the pseudoaneurysm may not affect the rate of rebleeding after TAE.