Intraabdominal hemorrhage complicating surgical management of necrotizing pancreatitis

Surgical management of necrotizing pancreatitis (NP) may result in significant intraabdominal hemorrhage requiring intervention. To determine the incidence and management of hemorrhage complicating operative management of NP, we analyzed retrospectively all patients undergoing operative treatment of NP between 1985 and 1994. Thirteen of 61 patients (21%) developed intraabdominal hemorrhage requiring intervention. The five patients (38%) who experienced more than one bleeding episode had undergone more prior operative debridements (mean of 5.6 vs. 3.8), had had higher transfusion requirements during the first bleeding episode (mean of 27.4 vs. 11.3 U of packed red blood cells), and had a higher hospital mortality (60 vs. 38%) compared to patients with only one bleeding episode. Coexistence of pancreatic and/or gastrointestinal fistula was more common in patients who developed bleeding (36 vs. 11%). Seventeen bleeding sites (eight venous, seven arterial, two generalized oozing) were identified. Angiography was successful in one of two patients in whom it was employed. Surgical control was effective in the other 12 patients. There was no acute mortality related to hemorrhage, but the hospital mortality was greater than in those without hemorrhage (46 vs. 21%). We conclude that significant hemorrhage complicates the surgical management of NP in ~20% of patients; while it can be effectively controlled surgically and does not lead to immediate mortality, it may predict worse prognosis.