Diagnostic and Therapeutic Strategies to Manage Post-Pancreaticoduodenectomy Hemorrhage
- 544 Downloads
To explore the causes, diagnosis and treatment of post-pancreaticoduodenectomy hemorrhages (PPHs).
A database of 703 pancreaticoduodenectomy patients in our institution (January 2008–July 2013) was analyzed retrospectively.
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).
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.
KeywordsPancreatic Fistula Bleeding Site Stress Ulcer Abdominal Infection Artery Hemorrhage
Grant support for the research reported
Conflict of interests
All authors declare that there is no conflict of interests.
- 10.Gao QX, Lee HY, Wu WH et al (2012) Factors associated with post-pancreaticoduodenectomy hemorrhage: 303 consecutive cases analysis. Chin Med J (Engl) 125:1571–1575Google Scholar
- 14.Ricci C, Casadei R, Buscemi S et al (2012) Late postpancreatectomy hemorrhage after pancreaticoduodenectomy: is it possible to recognize risk factors? JOP 13:193–198Google Scholar
- 19.Cameron JL, Riall TS, Coleman J et al (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15Google Scholar