Vascular complications of chronic pancreatitis and its management

Abstract

Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.

Keywords: Chronic pancreatitis; Pseudoaneurysm; Vascular complications; Varices; Venous thrombosis

Core Tip: Patients with chronic pancreatitis (CP) are prone to various venous and arterial complications that may sometimes lead to life-threatening bleed. A prompt approach to such vascular complications includes early identification and appropriate management by various modalities including endovascular, percutaneous, endoscopic ultrasound-guided, or surgical in certain cases. A knowledge of these complications, their presentation, and management are important for improving outcomes in patients with CP.