Massive arterial hemorrhage in patients with pancreatitis. Complementary roles of surgery and transcatheter occlusive techniques.

Massive arterial hemorrhage from multiple sites caused by tissue injury and infection following severe pancreatitis occurred in 12 patients, who were treated with the combination of angiographic embolization techniques and surgery; five survived. Complete hemostasis was obtained in eight of 12 patients who underwent primary angiographic therapy. Bleeding was temporarily controlled in two patients, who then underwent directed surgical ligation of the bleeding vessel under more favorable conditions. In two patients, bleeding was not controlled. The use of permanent occluding materials, particularly bucrylate, resulted in the highest success rate. When the bleeding artery could not be individually catheterized for safe occlusion, balloon occlusion or vasopressin infusion stabilized the patient's condition, with a decrease in the rate of bleeding prior to subsequent surgical therapy. Inadequate control of further tissue necrosis and sepsis was the cause of death in five of the seven patients who died. The other two patients died of recurrent hemorrhage despite attempts at both arteriographic occlusion and surgical ligation.