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Journal of Gastrointestinal Surgery

, Volume 13, Issue 5, pp 922–928 | Cite as

Results of Non-operative Therapy for Delayed Hemorrhage after Pancreaticoduodenectomy

  • Laura Beyer
  • Rémi Bonmardion
  • Sandrine Marciano
  • Olivier Hartung
  • Olivier Ramis
  • Lénaïk Chabert
  • Marc Léone
  • Olivier Emungania
  • Pierre Orsoni
  • Marc Barthet
  • Stéphane V. Berdah
  • Christian Brunet
  • Vincent MoutardierEmail author
Original Article

Abstract

Introduction

Hemorrhage after pancreaticoduodenectomy is a life-threatening complication, which occurs in 4% to 16% of cases, even in experienced centers. Many diagnostic and therapeutic options exist but no one has yet established management guidelines. This study aimed to determine the role of conservative management in delayed hemorrhage.

Patients and methods

From January 2005 to August 2008, 87 patients underwent pancreaticoduodenectomy at our center. We reviewed, retrospectively, the medical charts of all patients who had experienced postoperative hemorrhage.

Results and discussion

Early hemorrhage occurred in one patient, who underwent successful reoperation. Nine patients presented with delayed hemorrhage (10.3%), including three with sentinel bleeding. Mean onset was 20 days post-surgery. We used the same initial management for each patient: all had an urgent contrast computed tomography scan. In every case, the bleeding site was arterial. Conservative treatment (embolization or covered stent) was successful in every case. We reoperated on two patients for gastrointestinal perforation, at 9 days and 2 months after embolization, respectively. We transferred seven patients to an intensive care unit, with an average stay of 8 days. Mean hospital stay was 43 days (33–60). All patients survived.

Conclusion

Conservative management, combining endovascular procedures and aggressive resuscitation, is appropriate for most cases of delayed hemorrhage after pancreaticoduodenectomy.

Keywords

Pancreatoduodenectomy Hemorrhage Covered stent Embolization 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Laura Beyer
    • 1
  • Rémi Bonmardion
    • 1
  • Sandrine Marciano
    • 2
  • Olivier Hartung
    • 3
  • Olivier Ramis
    • 2
  • Lénaïk Chabert
    • 5
  • Marc Léone
    • 5
  • Olivier Emungania
    • 1
  • Pierre Orsoni
    • 1
  • Marc Barthet
    • 4
  • Stéphane V. Berdah
    • 1
  • Christian Brunet
    • 1
  • Vincent Moutardier
    • 1
    Email author
  1. 1.Department of Digestive SurgeryAssistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la MéditerranéeMarseille Cedex 20France
  2. 2.Department of RadiologyAssistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la MéditerranéeMarseille Cedex 20France
  3. 3.Department of Vascular SurgeryAssistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la MéditerranéeMarseille Cedex 20France
  4. 4.Department of GastroenterologyAssistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la MéditerranéeMarseille Cedex 20France
  5. 5.Department of Intensive CareAssistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la MéditerranéeMarseille Cedex 20France

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