Clinical Analysis Of Acute Pancreatitis Complicated With Upper Gastrointestinal Hemorrhage: A Report Of 25 Cases

Objective:To explore the clinical characteristics and treatments of acute pancreatitis complicated with upper gastrointestinal haemorrhage.Methods:Clinical data of 25 cases of acute pancreatitis with upper gastrointestinal hemorrhage were reviewed retrospectively between 2002 and 2010. Additional 52 cases of SAP without hemorrhage were in the control group. The patients were divided into two groups, compared the clinical featuresResults:In the hemorrhage group,84%(21/25)was men, and the ratio of them was 57.69% (30/52) in control group. There were statistical diff-erences between the hemorrhage group and the control group in sex composition (P=0.022), and male patients accounted for the majority of the population in the hemorrhage group. The average age of the hemorrhage group was higher than the control group (58.52±15.85 vs 49.9±14.44, P= 0.017). Patient's APACHEⅡscore in 24h was higher in the hemorrhage group(16.24±5.75vs11.42±4.16, P= 0.001).The use ratio of glucocorticoid in the control group was higher than the hemorrhage group (80.77% vs 48.00%, P= 0.003).The ratio of minimally invasive surgery and intervenient treatment was lower than the control group (8.00% vs 48.07%, P= 0.002).The ratio of shock before the hemorrhage in the bleeding group was higher (44.00% vs 21.15%, P= 0.038). There was no significant difference in bacterial or fungal infection of two groups (P> 0.05). The hemorrhage group and the control group were different in the prophylactic use of acid-suppressing drugs (P= 0.02).The mortality rate in bleeders was higher than that in nonbleeders (52% vs 7.69%, P= 0.000).Of the hemorrhage group, they were stress ulcer bleeding, except 1 case with regional portal hypertension leading to bleeding.Conclusion:Upper gastrointestinal hemorrhage was maily caused by stress ulcer in acute pancreatitis. Stress ulcer bleeding often occurred in SAP patients. Reasonable therapies might decreases the incidence of bleeding in SAP, which consist of appropriate application of glucocorticoid, TPN&EN, peritoneal lavage,application of proton pump inhibitors and control shock...