Pancreatitis: Preventing catastrophic haemorrhage

Table 1 Early vs late pancreatitis

Early phase pancreatitis	Late phase pancreatitis
Systemic disturbances result from the host response to local pancreatic injury.	Persistence of systemic signs of inflammation.
Clinical manifestation with associated SIRS response.	Presence of local complications.
Usually lasts less than one week but may extend into the second week.	Compensatory inflammatory response syndrome.
Severity determined by presence of organ failure. Transient < 48 h. Persistent > 48 h.

Table 2 Defining pancreatic severity

Mild acute pancreatitis	No organ failure
	No local complications
Moderately severe acute pancreatitis	Organ failure that resolves within 48 h (transient organ failure) and/or
	Local or systemic complications without persistent organ failure
Severe acute pancreatitis	Persistent organ failure (single/multiple) > 48 h

Table 3 Defining pancreatic and peri-pancreatic collections

Acute peri-pancreatic fluid collection	Don not have well defined walls
	Homogenous, confined to normal fascial planes in retroperitoneum
	May be multiple
	Likely to develop into a pseudocyst if they persist > 4 wk
Pancreatic pseudocyst	Fluid collection in peri-pancreatic tissues
	Occasionally partly/totally intra-pancreatic
	Well defined wall with essentially no solid material
	Occur typically after 4 wk
Acute necrotic collection	Fluid collection within the first 4 wk containing necrotic tissue and fluid.
	Presence of necrosis differentiates it from APFC
Walled off necrosis	Necrotic tissue contained within an enhancing wall of reactive tissue
	Usually occurs > 4 wk after the onset of necrotising pancreatitis
Infected necrosis	Presence of gas within collection
	Positive cultures post FNA

APFC: Acute peri-pancreatic fluid collection.

Table 4 Different types and incidence of vascular complications in pancreatitis

Vascular complications of pancreatitis	Incidence
Arterial complications	1.3%-10% of patients with pancreatitis
Ruptured pseudo-aneurysm	60% of all acute haemorrhage in pancreatitis
Haemorrhagic pseudocysts without pseudoaneurysms	20% of all acute haemorrhage in pancreatitis
Capillary, venous or small vessel haemorrhage	20% of all acute haemorrhage in pancreatitis
Venous complications	1%-23% of patients with pancreatitis
Portal vein thrombosis	23% of patients with pancreatitis
Splenic vein thrombosis	22% of patients with pancreatitis
Superior mesenteric vein thrombosis	19% of patients with pancreatitis