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World Journal of Surgery

, 35:2543 | Cite as

Post-pancreaticoduodenectomy Hemorrhage. Incidence, Diagnosis, and Treatment

  • M. J. Mañas-GómezEmail author
  • R. Rodríguez-Revuelto
  • J. Balsells-VallsEmail author
  • J. J. Olsina-Kissler
  • M. Caralt-Barba
  • M. Pérez-Lafuente
  • R. Charco-Torra
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Superior Mesenteric Artery Pancreatic Fistula Arteriovenous Malformation Biliary Fistula Gastrojejunal Anastomosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors are grateful to Christine O’Hara for valuable revision of the English version of this article.

Conflicts of interest

None.

Financial support

None.

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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • M. J. Mañas-Gómez
    • 1
    Email author
  • R. Rodríguez-Revuelto
    • 1
  • J. Balsells-Valls
    • 1
    Email author
  • J. J. Olsina-Kissler
    • 2
  • M. Caralt-Barba
    • 1
  • M. Pérez-Lafuente
    • 3
  • R. Charco-Torra
    • 1
  1. 1.Department of HBP Surgery and TransplantHospital Universitari Vall d’Hebrón, Autonomous University of BarcelonaBarcelonaSpain
  2. 2.Department of General SurgeryHospital Arnau de Vilanova de LleidaLeridaSpain
  3. 3.Department of AngioradiologyHospital Universitari Vall d’HebrónBarcelonaSpain

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