Abstract
<jats:p>Objective. To systematize the results of various treatment methods for patients with pancreatic hemorrhage as a complication of chronic pancreatitis. Materials and Methods. A retrospective analysis was conducted of the treatment outcomes of 47 patients with pancreatic hemorrhage against a background of chronic pancreatitis during the period from 2015 to 2025. There were 36 men and 11 women aged 25 to 71 years. The mean age of the patients was (47 ± 11) years. The diagnosis was verified based on the clinical triad (pain, bleeding, hyperamylasemia) and data from multislice computed tomography of the abdominal organs and digital subtraction angiography, which confirmed the presence of pseudocysts or pseudoaneurysms. The treatment strategy consisted of performing endovascular interventions (in 33 patients), open surgeries (in 9 patients), and conservative therapy (in 5 patients). Treatment efficacy was assessed based on the frequency of hemostasis achievement, recurrence, and mortality rates. Results. Clinically, pain was the predominant symptom in all patients (100%), while overt signs of gastrointestinal bleeding varied (melena–12.8%, hematemesis–4.3%, and a combination of symptoms–4.2%). Anemia was detected in 34.0% of patients, and hyperamylasemia in 23.4%. According to imaging data, the main sources of bleeding were the gastric and duodenal (42.9%) and splenic (30.0%) arteries; calcifications were detected in the immediate vicinity of the affected vessel in 42.6% of patients. Endovascular hemostasis, performed in 33 (70.2%) patients, had a technical success rate of 100%. The primary clinical efficacy of the method was 61.7%, and the overall efficacy after repeat angiographic interventions was 70.2%. Surgical treatment, performed in 9 (19.2%) patients with recurrences or hemodynamic instability, had a 100% success rate. The overall efficacy of the multimodal approach was 97.9%, mortality was 2.1%, and the recurrence rate was 19.2%. Predictors of an unfavorable course were identified as massive blood loss, infection of a pseudocyst, localization in the gastro-duodenal artery basin, and the presence of pararterial calcifications. Conclusions. The implementation of a multimodal approach with the priority use of endovascular hemostasis as a first-line method is a highly effective and safe strategy for treating pancreatic hemorrhage, allowing for successful clinical outcomes with a minimal mortality rate.</jats:p>