Skip to main content
SpringerLink
Log in

Diagnostic and Therapeutic Strategies to Manage Post-Pancreaticoduodenectomy Hemorrhage

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Objective

To explore the causes, diagnosis and treatment of post-pancreaticoduodenectomy hemorrhages (PPHs).

Methods

A database of 703 pancreaticoduodenectomy patients in our institution (January 2008–July 2013) was analyzed retrospectively.

Results

PPHs occurred in 62 patients of which, 38 had clear causes and 15 died because of uncontrolled bleeding and multiple organ failure. Pancreatic fistula and abdominal infection rates were significantly higher in the PPH group compared to the group who did not experience hemorrhages (P < 0.05) but did not significantly increase the mortality of PPH patients. Hemostasis was attempted by endotherapy in 7 patients and was successful in 4 (57.1 %). Angioembolization was performed in 12 patients and was successful in 10 (83.3 %) and relaparotomy in 24 patients successful in 13 (54.2 %). All deceased patients belonged to International Study Group of Pancreatic Surgery clinical grade C and sentinel bleeding occurred in 60 % of PPH mortalities (9/15) (P = 0.005).

Conclusion

Pancreatic fistulae and abdominal infections are associated with PPH. Control of early mild upper gastrointestinal hemorrhages could be attempted by endotherapy, but angiography with intervention or surgical treatments were always required for delayed bleeding. The mortality in cases with sentinel bleedings was obviously increased.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Correa-Gallego C, Brennan MF, D’Angelica MI et al (2012) Contemporary experience with postpancreatectomy hemorrhage: results of 1,122 patients resected between 2006 and 2011. J Am Coll Surg 215:616–621

    Article  PubMed  Google Scholar 

  2. Blanc T, Cortes A, Goere D et al (2007) Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated? Am J Surg 194:3–9

    Article  PubMed  Google Scholar 

  3. de Castro SM, Kuhlmann KF, Busch OR et al (2005) Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg 241:85–91

    PubMed Central  PubMed  Google Scholar 

  4. Koukoutsis I, Bellagamba R, Morris-Stiff G et al (2006) Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed. Dig Surg 23:224–228

    Article  CAS  PubMed  Google Scholar 

  5. Rajarathinam G, Kannan DG, Vimalraj V et al (2008) Post pancreaticoduodenectomy haemorrhage: outcome prediction based on new ISGPS Clinical severity grading. HPB (Oxford) 10:363–370

    Article  CAS  Google Scholar 

  6. Sanjay P, Fawzi A, Fulke JL et al (2010) Late post pancreatectomy haemorrhage. Risk factors and modern management. JOP 11:220–225

    PubMed  Google Scholar 

  7. Sato N, Yamaguchi K, Shimizu S et al (1998) Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg 133:1099–1102

    CAS  PubMed  Google Scholar 

  8. Yekebas EF, Wolfram L, Cataldegirmen G et al (2007) Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 246:269–280

    Article  PubMed Central  PubMed  Google Scholar 

  9. Choi SH, Moon HJ, Heo JS et al (2004) Delayed hemorrhage after pancreaticoduodenectomy. J Am Coll Surg 199:186–191

    Article  PubMed  Google Scholar 

  10. Gao QX, Lee HY, Wu WH et al (2012) Factors associated with post-pancreaticoduodenectomy hemorrhage: 303 consecutive cases analysis. Chin Med J (Engl) 125:1571–1575

    Google Scholar 

  11. Manas-Gomez MJ, Rodriguez-Revuelto R, Balsells-Valls J et al (2011) Post-pancreaticoduodenectomy hemorrhage. Incidence, diagnosis, and treatment. World J Surg 35:2543–2548

    Article  CAS  PubMed  Google Scholar 

  12. Tien YW, Lee PH, Yang CY et al (2005) Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg 201:554–559

    Article  PubMed  Google Scholar 

  13. Wei HK, Wang SE, Shyr YM et al (2009) Risk factors for post-pancreaticoduodenectomy bleeding and finding an innovative approach to treatment. Dig Surg 26:297–305

    Article  PubMed  Google Scholar 

  14. Ricci C, Casadei R, Buscemi S et al (2012) Late postpancreatectomy hemorrhage after pancreaticoduodenectomy: is it possible to recognize risk factors? JOP 13:193–198

  15. Lee HG, Heo JS, Choi SH et al (2010) Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy. World J Gastroenterol 16:1239–1244

    Article  PubMed Central  PubMed  Google Scholar 

  16. Brodsky JT, Turnbull AD (1991) Arterial hemorrhage after pancreatoduodenectomy. The ‘sentinel bleed’. Arch Surg 126:1037–1040

    Article  CAS  Google Scholar 

  17. Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25

    Article  PubMed  Google Scholar 

  18. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  19. Cameron JL, Riall TS, Coleman J et al (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15

    Google Scholar 

  20. Reddy JR, Saxena R, Singh RK et al (2012) Reoperation following Pancreaticoduodenectomy. Int J Surg Oncol 2012:218248

    CAS  PubMed Central  PubMed  Google Scholar 

  21. Hur S, Yoon CJ, Kang SG et al (2011) Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques. J Vasc Interv Radiol 22:294–301

    Article  PubMed  Google Scholar 

  22. Robinson K, Rajebi MR, Zimmerman N et al (2013) Post-pancreaticoduodenectomy hemorrhage of unusual origin: treatment with endovascular embolization and the value of preoperative CT angiography. J Radiol Case Rep 7:29–36

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rumstadt B, Schwab M, Korth P et al (1998) Hemorrhage after pancreatoduodenectomy. Ann Surg 227:236–241

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Khorsandi SE, Limongelli P, Jackson JE et al (2008) Management of delayed arterial hemorrhage after pancreaticoduodenectomy. A case series. JOP 9:172–178

    PubMed  Google Scholar 

  25. Beyer L, Bonmardion R, Marciano S et al (2009) Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy. J Gastrointest Surg 13:922–928

    Article  PubMed  Google Scholar 

  26. Limongelli P, Khorsandi SE, Pai M et al (2008) Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis. Arch Surg 143:1001–1007

    Article  PubMed  Google Scholar 

  27. Meng XF, Wang J, Wang ZJ et al (2012) Delayed massive hemorrhage after pancreaticoduodenectomy. Zhonghua Yi Xue Za Zhi 92:1119–1121

    PubMed  Google Scholar 

  28. Zhang J, Zhu X, Chen H et al (2011) Management of delayed post-pancreaticoduodenectomy arterial bleeding: interventional radiological treatment first. Pancreatology 11:455–463

    Article  PubMed  Google Scholar 

  29. Treckmann J, Paul A, Sotiropoulos GC et al (2008) Sentinel bleeding after pancreaticoduodenectomy: a disregarded sign. J Gastrointest Surg 12:313–318

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Grant support for the research reported

None.

Conflict of interests

All authors declare that there is no conflict of interests.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Chinese PLA General Hospital, No 28 Fuxing Road, Beijing, 100853, China

    Jian-feng Chen, Shi-feng Xu, Wei Zhao, Yuan-hu Tian & Jia-Hong Dong

  2. Department of Hepatobiliary Surgery, No. 401 Hospital of Chinese PLA, No 22 Minjiang Road, Qingdao, 266071, China

    Jian-feng Chen, Lin Gong & Wei-sheng Yuan

  3. Department of Hepatobiliary Surgery, Shandong Provincial Hospital, No 324 Jingwu Weiqi Road, Jinan, 250012, China

    Shi-feng Xu

  4. Department of Hepatobiliary Surgery, Affiliated Hospital of Medical College Qingdao University, No 16 Jiangsu Road, Qingdao, 255000, China

    Wei Zhao

Authors
  1. Jian-feng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shi-feng Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuan-hu Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lin Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei-sheng Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jia-Hong Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jia-Hong Dong.

Additional information

Jian-feng Chen and Shi-feng Xu contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Jf., Xu, Sf., Zhao, W. et al. Diagnostic and Therapeutic Strategies to Manage Post-Pancreaticoduodenectomy Hemorrhage. World J Surg 39, 509–515 (2015). https://doi.org/10.1007/s00268-014-2809-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2809-3

Keywords

Search

Navigation