EMBOLIZATION AND ADMINISTRATION OF COAGULATION FACTORS IN COMPLEX TREATMENT OF RECURRENT EROSIVE BLEEDING IN PANCREATIC NECROSIS sev-alex@mail.ru

211-01

EMBOLIZATION AND ADMINISTRATION OF COAGULATION FACTORS IN COMPLEX TREATMENT OF RECURRENT EROSIVE BLEEDING IN PANCREATIC NECROSIS

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Russia

Oral or Poster

The course of severe acute pancreatitis complicated by hemorrhage is associated with the final unfavorable outcome of treatment of this group of patients. The overall incidence of all gastrointestinal bleeding in acute pancreatitis reaches 23%. The greatest difficulty in diagnostics and treatment are arrosive parapancreatic intra-abdominal bleedings without clear arteriographic localization at the stage of development of purulent-septic complications of pancreonecrosis (fatality up to 100%). The aim of the study was to evaluate the efficacy and safety of the technique of endovascular embolization and introduction of coagulation factors in the treatment of arrosive bleedings in acute pancreatitis.

The treatment of patients with pancreonecrosis in intensive care with developed arterial hemorrhage for the period of 2023-2025 was evaluated. In treatment of these patients (after ineffectiveness of standard methods of stitching and tamponade of bleeding areas) we used endovascular total embolization of splenic artery with creation of the “steal- syndrome” of blood circulation in the pancreas, and further systemic administration of coagulation factors, which in conditions of slow blood flow allows to form a stable hemostasis.

The technique was patented (Russia). In total 6 patients were treated. M:W- 5:1. The average age was 46 years (39-62). Apart from arrosive bleeding all patients had characteristic complications connected with severe course of pancreonecrosis. The lethality due to bleeding constituted 0%.

Embolization of the arterial vessel supplying the pancreas in combination with systemic use of coagulation factors could to stop almost fatal parapancreatic intra-abdominal bleeding at the stage of purulent-septic complications of pancreonecrosis.