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- W2078162779 abstract "Introduction: Among the rare causes of „difficult-to-diagnose-and-treat“ gastrointestinal bleedings are the haemobilia and Wirsungorrhagia. Patients and methods: During 8 years nine patients were admitted to our department with life threatening bleeding from the papilla of Vater. We had two cases of iatrogenic pseudoaneurysm after laparoscopic cholecystectomy. Both patients required more than 20 units of blood suspension. One of them did not survive despite surgical and endoscopic interventions, while in the other, a 25 year-old patient, the transarterial embolization of the left hepatic artery was succesfully performed. In 3 cases we met massive haemobilia (25/9/10 units of blood suspension were required respectively) due to inoperable neoplasms of the common bile duct. In all cases metal stent was iserted. After this procedure in 2 cases the bleeding stopped, while in another patient it was surgically sutured. In the other four cases the pseudoaneurysm was caused by acute or chronic pancreatitis. 2 patients were haemodynamically unstable and/or angiography was unavailable, thus emergency surgery was performed. In one patient angio-CT demonstrated the pseudoaneurysm, and angio-embolization was performed succesfully, ten days later elective cystojejunostomy was performed. In the last case endoscopic cystogastrostomy was performed. Conclusion: Contrast enhanced angio-CT and angiography can be diagnostic in the majority of patients with massive gastrointestinal bleeding from the papilla of Vater. Selective angiographic embolization gives good immediate results in haemodynamically stable cases. Surgery is required in case of haemodynamic instability, when embolization fails or unavailable, or during the recurrence of bleeding after embolization. In inoperable intraductal malignancies, as the less invasive method, endoscopic interventions may be successful." @default.
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- W2078162779 date "2007-05-01" @default.
- W2078162779 modified "2023-09-26" @default.
- W2078162779 title "Massive gastrointestinal bleeding – do not overlook the role of the pancreatobiliary system" @default.
- W2078162779 doi "https://doi.org/10.1055/s-2007-982720" @default.
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