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World Journal of Surgery

, Volume 39, Issue 2, pp 509–515 | Cite as

Diagnostic and Therapeutic Strategies to Manage Post-Pancreaticoduodenectomy Hemorrhage

  • Jian-feng Chen
  • Shi-feng Xu
  • Wei Zhao
  • Yuan-hu Tian
  • Lin Gong
  • Wei-sheng Yuan
  • Jia-Hong DongEmail author
Original Scientific Report

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.

Keywords

Pancreatic Fistula Bleeding Site Stress Ulcer Abdominal Infection Artery Hemorrhage 
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

None.

Grant support for the research reported

None.

Conflict of interests

All authors declare that there is no conflict of interests.

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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Jian-feng Chen
    • 1
    • 2
  • Shi-feng Xu
    • 1
    • 3
  • Wei Zhao
    • 1
    • 4
  • Yuan-hu Tian
    • 1
  • Lin Gong
    • 2
  • Wei-sheng Yuan
    • 2
  • Jia-Hong Dong
    • 1
    Email author
  1. 1.Department of Hepatobiliary SurgeryChinese PLA General HospitalBeijingChina
  2. 2.Department of Hepatobiliary SurgeryNo. 401 Hospital of Chinese PLAQingdaoChina
  3. 3.Department of Hepatobiliary SurgeryShandong Provincial HospitalJinanChina
  4. 4.Department of Hepatobiliary SurgeryAffiliated Hospital of Medical College Qingdao UniversityQingdaoChina

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