Haemorrhagic pancreatitis
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Shah V, Hartung M, et al. Haemorrhagic pancreatitis. Reference article, Radiopaedia.org (Accessed on 27 Mar 2025) https://doi.org/10.53347/rID-17667
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rID:
17667
Article created:
Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Jeremy Jones had no recorded disclosures.
View Jeremy Jones's current disclosures
Revisions:
16 times, by
14 contributors -
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Systems:
Synonyms:
- Haemorrhagic complicating pancreatitis
- Pancreatitis complicated by haemorrhage
- Hemorrhagic pancreatitis
- Pancreatitis complicated by hemorrhage
Haemorrhagic pancreatitis is characterised by bleeding within or around the pancreas, and is usually considered a late sequela of acute pancreatitis.
Pathology
Haemorrhage can occur in patients with severe necrotising pancreatitis or as a result of pancreatic pseudoaneurysm rupture when it constitutes a life-threatening emergency.
Aetiology
According to one study, the usual causes of haemorrhage were 2:
- bleeding pancreatic pseudoaneurysm or peripancreatic pseudoaneurysm: ~60%
- diffuse bleeding with pancreatic necrosis: ~20%
- haemorrhagic pancreatic pseudocysts: ~20%
Radiographic features
CT
Acute haemorrhage typically has high attenuation on unenhanced CT scans. The attenuation value then decreases as the haematoma ages through time 5.
MRI
Haemorrhagic fluid collections are more evident on MRI than CT due to the following reasons 1:
- T1: high-signal intensity methaemoglobin
- T2: low-signal intensity haemosiderin rim
Signal abnormalities due to haemorrhage remain visible longer on MRI than on CT.
References
- 1. Miller FH, Keppke AL, Dalal K et-al. MRI of pancreatitis and its complications: part 1, acute pancreatitis. AJR Am J Roentgenol. 2004;183 (6): 1637-44. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Balthazar EJ, Fisher LA. Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging. Pancreatology. 2001;1 (4): 306-13. - Pubmed citation
- 3. Ammori BJ, Madan M, Alexander DJ. Haemorrhagic complications of pancreatitis: presentation, diagnosis and management. Ann R Coll Surg Engl. 1998;80 (5): 316-25. - Free text at pubmed - Pubmed citation
- 4. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223 (3): 603-13. doi:10.1148/radiol.2233010680 - Pubmed citation
- 5. Sahni VA, Mortelé KJ. The bloody pancreas: MDCT and MRI features of hypervascular and hemorrhagic pancreatic conditions. AJR Am J Roentgenol. 2009;192 (4): 923-35. doi:10.2214/AJR.08.1602 - Pubmed citation
- 6. Vujic I. Vascular complications of pancreatitis. Radiol. Clin. North Am. 1989;27 (1): 81-91. - Pubmed citation
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