Endovascular treatment of hemorrhagic pancreatic pseudocyst and correlation with preoperative radiological fndings

Purpose: The aim of this study was to analyze the results of endovascular embolization (EVE) in hemorrhagic pancreatic pseudocyst (HPP) treatment and correlation with preoperative computed tomography (CT) fndings. Materials and Methods: In retrospective single center study patients with EVE due to HPP included. Potential source of bleeding on CT was correlated to EVE site. Postembolization laparotomy incidence, hospitalization length, radiological changes of HPP on follow-up CT were analyzed. Results: 52 patients were included: 80%- male, 20% - female, mean age 49 years. Pseudoaneurysm found on CT in 27% (n=14), 73% (n=38) - exact bleeding site was not detectable leading to empirical EVE. HPP of pancreatic head often lead to EVE of a. gastro-/pancreaticoduodenalis (46%, p>0.05). Pancreatic body HPP- EVE of a.lienalis - 79% (p<0.05) or a. gastrica sinistra 14% (p>0.05); a.gastrica sinistra+a.lienalis - 7% (n=1). Pancreatic tail HPP- EVE a.lienalis in 84%(p<0.05); EVE was performed with coils: median length of pushable coils - 56 cm, detachable coils- 105 cm. Median hospitalization- 23,3 days. Median HGB on admission 10,68g/L. After EVE 11 patients underwent laparotomy for pancreatic necrectomy. No laparotomies due to rebleeding detected. On follow-up CT (n=32) 3% had no visual changes in HPP, 3%- enlargement of the HPP, 25%- reduction of HPP size, 63% resolution of HPP. Conclusion: Statistically signifcant correlation between HPP in pancreatic body/tail on CT and EVE of a. lienalis was found. Preoperative CT plays important role before empirical EVE. EVE of HPP serves as a primary minimally invasive treatment option for clinical stabilization