Clinical Impact of Pancreatic and Peripancreatic Hemorrhage Associated With Acute Pancreatitis

Purpose The significance of pancreatitis-associated hemorrhage outside the context of a ruptured pseudoaneurysm remains unclear. This study aims to characterize the clinical significance of pancreatic hemorrhage during acute pancreatitis (AP). Methods This retrospective study included adult patients diagnosed with hemorrhagic pancreatitis (HP) from 2010 to 2021. HP was defined as a clinical diagnosis of AP and the presence of pancreatic or peripancreatic hemorrhage on cross-sectional imaging. Two radiologists assessed the pancreatitis type, degree of necrosis, hemorrhage location, peripancreatic collections, and peripancreatic vessels. Demographic and disease data, AP severity, and treatment decisions from admission to 3 months after discharge were extracted from hospital electronic health records. Results The study included 36 patients, stratified by AP severity into 12 (33.3%) mild, 13 (36.1%) moderate-severe, and 11 (30.6%) severe cases. Six (16.6%) of the patients experienced clinically significant bleeding, which led to changes in clinical management such as further imaging, modifications to anticoagulation regimens, or both. Among these, 50% (3 of 6) demonstrated active bleeding on further imaging, with 33% (2 of 6) of the bleeding being intrapancreatic. In contrast, 83% (30 of 36) of HP patients did not have clinically significant bleeding, and all but one did not require changes in clinical management. AP-associated splanchnic vein thrombosis occurred in 30.6% (11 of 36) of patients, and anticoagulation in these patients did not result in clinically significant bleeding. Conclusions HP without clinically significant bleeding does not necessitate changes in clinical management. However, hemorrhage may indicate more severe disease and is associated with a higher incidence of splanchnic vein thrombosis.