Post-pancreaticoduodenectomy Hemorrhage. Incidence, Diagnosis, and Treatment
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Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands out; it is associated with high mortality and there is no standard management. The aim of the present study was to analyze the incidence, diagnosis, and treatment of hemorrhage post-cephalic PD at our center.
From January 2005 to December 2008, 107 PDs were performed. A retrospective review of characteristics of patients with postoperative hemorrhage was made from our prospective database. Demographic data, diagnosis, treatment (medical, laparotomy, interventional radiology), association with fistula (pancreatic or biliary), intra- or extraluminal hemorrhage, bleeding time (early or late), severity (moderate/severe), and mortality were analyzed.
Eighteen patients (18/107; 16.82%) hemorrhaged after PD. Hemorrhage appeared early (< 24 h) in 4 of these 18 patients (22.2%), and it was severe in 13/18 (72%). Hemorrhage-related mortality was 11% (2/18) and hospital mortality was 22.2% (4/18). Arteriography was performed in 8/18 patients (44.4%) and was effective in 6/8 (75%); laparotomy was performed in 8/18 (44.4%). Re-bleeding occurred in 5 of these 18 patients after the first treatment (27.8%). An association between hemorrhage and fistula was observed.
Hemorrhage after pancreatic resection must be considered a complication with relatively high mortality. Diagnosis should be established and treatment applied rapidly. Pancreatic and/or biliary fistulae were significantly associated with a higher risk of postoperative hemorrhage. Interventional radiology is a good therapeutic option.
KeywordsSuperior Mesenteric Artery Pancreatic Fistula Arteriovenous Malformation Biliary Fistula Gastrojejunal Anastomosis
The authors are grateful to Christine O’Hara for valuable revision of the English version of this article.
Conflicts of interest
- 2.Rajarathinam G, Kannan DG, Vimalraj V et al (2008) Post pancreaticoduodenectomy haemorrhage: outcome prediction based on new IGPS, clinical severity grading. HBP 10:363–370Google Scholar
- 3.Tsirlis T, Vasiliades G, Koliopanos A et al (2009) Pancreatic leak related hemorrhage following pancreaticoduodenectomy. A case series. JOP J Pancreas 10:492–495Google Scholar
- 4.Tien Y, Lee P, Yang C et al (2001) Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg 4:554–559Google Scholar
- 14.Khorsandi SE, Limongelli P, Jackson JE et al (2008) Management of delayed arterial hemorrhage after pancreaticoduodenectomy. A case series. JOP J Pancreas 9:172–178Google Scholar
- 18.Sanjay P, Fawzi A, Fulke JL et al (2010) Late post pancreatectomy haemorrhage. Risk factors and modern management. JOP J Pancreas 11:220–225Google Scholar