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Haemorrhagic Shock as a Result of Bleeding to Pancreatic Pseudocysts - The Problem of Emergency Service

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Olejarz A., Nowikiewicz T., Piotrowski L.
Polish Journal of Surgery
|
2009
|
vol. 81
|
issue 4
193-197
EN
Pancreatic pseudocysts (PPC) depending on their size and location can cause life-threatening complications. The paper focuses on an infrequent cause of a haemorrhagic shock that can pose a substantial diagnostic and surgical problem, especially during emergency service.Material and methods. In the years 1997-2002 five patients with bleeding to pancreatic pseudocysts were operated on due to urgent indications. In all of them the symptoms of bleeding into the digestive tract or to the retroperitoneal space diagnosed as a hypovolemic shock was the only indication to an urgent surgical intervention. The analysis was carried out on epidemiological data of patients, manner of treatment and its results.Results. The group of patients consisted of 4 man and 1 women of mean age 40.6 years. The majority of patients (4 - i.e. 80%) had a history of acute pancreatitis and severe alcohol abuse. All hospitalized patients needed, in the perioperative period, intensive shock-controlling procedures (average blood preparation transfusions at the level of 6.6 units). In total, six operation procedures were performed (in one case with subsequent relaparotomy) - in 4 cases it was distal pancreatic resection with PPC, in 1 case - retroperitoneal space packing and drainage. Finally, 4 cured patients left the hospital, 1 died (mortality rate 20%).Conclusions. PPC bleeding as a life threatening complication of acute pancreatitis requires quick diagnosis and effective treatment. A surgical procedure can be performed on many levels; the choice of an operation type depends on the patient's state, intraoperational conditions and the surgeon's experience.
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