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Year 2020 Vol. 28 No 6

GENERAL & SPECIAL SURGERY

К.М. KURBONOV, K.R. RUZIBOYZODA, S.G. ALI-ZADE

DIAGNOSIS AND TREATMENT OF PANCREATOGENIC BLEEDINGS

Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

Objective. To evaluate the results of providing care to patients with pancreatogenic bleeding.
Methods. The treatment results of patients (n=84) with pancreatogenic bleedings were analyzed. In 73 (86.9%) cases bleedings occurred after direct interventions on the pancreas (n=12) and purulent-septic complications of acute pancreatitis (AP) (n = 61). In 11 (13.1%) cases, bleedings occurred in chronic pancreatitis (CP) complicated by pseudocysts (PC) of the pancreas. Type A bleeding occurred in 42 (50%) cases, type B – in 26 (31%) , and type C – in 16 (19%). The results of the medical care quality were assessed depending on the type and severity of bleeding.
Results. Conservative therapy in 31 out of 42 cases with type A bleeding allowed achieving stable hemostasis. In 12 cases in pancreatogenic bleedings caused by gastric and duodenal ulcers penetrating into the pancreas, the method of the combined endoscopic hemostasis with antisecretory therapy was considered to be effective to achieve hemostasis. In the presence of intraperitoneal postoperative profuse bleedings of type B and C owing to pancreatonecrosis, relaparotomy was performed in 38 cases; the stitching of a bleeding vessel with the pancreas tamponade, sanation and drainage of the abdominal cavity was carried out in 7 cases. 18 lethal outcomes were registered. Resection of the tail pancreas with splenectomy was performed in 4 cases, in 9 cases to achieve hemostasis in bleedings from the pancreatic, the bleeding vessel was sutured with the external drainage and tamponing of the pancreatic pseuodocyst in 6 cases and longitudinal pancreatic jejunal anastomosis – in 3. Lethal outcomes were registered in 2 cases. In 2 cases, X-ray endovascular embolization of the gastroduodenal artery was performed. No morbidity and mortality were registered.
Conclusion. Bleeding accompanied by severe hemodynamic disturbances requires open surgical interventions. X-ray endovascular methods are considered to be effective in the case of bleeding due to acute and chronic pancreatitis and in the postlesional period.

Keywords: complication of pancreatitis, bleeding, pancreatitis, pseudoaneurysm, hemostasis, arrosive bleeding
p. 648-654 of the original issue
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Address for correspondence:
734003, Republic of Tajikistan,
Dushanbe, Rudaki Av.,139.
Avicenna Tajik State Medical University,
the Department of Surgical Diseases No1,
tel.: +992 934054404
e-mail: dr.hero85@mail.ru
Ruziboyzoda Kahramon R.
Information about the authors:
Kurbonov Karimкhon M., Academician of the Academy of Medical Sciences of the Republic of Tajikistan, Honored Worker of Science and Technology of the Republic of Tatarstan, Doctor of Medical Sciences (MD), Professor of the Department of Surgical Diseases No1 of Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0002-8100-9722.
Ruziboyzoda Kahramon R., PhD, Assistant of the Department of Surgical Diseases No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0001-8381-0364.
Ali-Zade Sukhrob G, PhD, Associate Professor of the Department of Surgical Diseases No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0002-2456-7509
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