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Entzündliche Arrosionsblutungen aus Viszeralarterien

Interventionelles und gefäßchirurgisches Management nach vorwiegend pankreaschirurgischen Eingriffen

Interventional and vascular surgical management for inflammatory arrosion hemorrhage from visceral arteries following pancreatic surgery

Der Chirurg volume 75, pages 1021–1028 (2004)Cite this article

Zusammenfassung

Spontane oder postoperative Arrosionsblutungen aus Viszeralarterien in die freie Bauchhöhle sind eine seltene, aber bedrohliche Situation. Die Letalität nach postoperativer Massivblutung wird in der Literatur mit ca. 2% angegeben. Die therapeutischen Möglichkeiten zur Blutungskontrolle sind an erster Stelle die Relaparotomie mit Versorgung des Blutungslecks oder als interventionelle Alternative der Einsatz von endovaskulären Kathetertechniken mit Implantation von Stentgrafts oder die Embolisation blutender Gefäßstümpfe.

Wir berichten über das diagnostische und therapeutische Vorgehen anhand von 7 Patienten mit Blutungen aus der A. gastroduodenalis (n=5) nach pankreaschirurgischen Interventionen bei Pankreaskopfkarzinom, Rezidiv eines Liposarkoms und chronischer Pankreatitis, der A. hepatica communis (n=1) bei chronischer Pankreatitis und der A. mesenterica superior (n=1) nach akuter Pankreatitis. Anhand von 4 Kasuistiken werden unsere Erfahrungen mit der Implantation von Stentgrafts (Hemobahn®-Prothesen) vermittelt. Den Vorteil der Stentgrafts sehen wir in der sofortigen Blutstillung bei fehlendem Kontakt der Endoprothese zu infiziertem Gewebe und Erhalt der Perfusion des abhängigen Organs. Unsere positiven Erfahrungen mit diesen interventionellen Therapieverfahren erfordern jedoch weitere klinische Untersuchungen, wobei im Mittelpunkt die Indikationen, die technische Erfolgsrate, die stentbedingten Komplikationen und die Langzeitverläufe stehen sollten.

Abstract

Spontaneous or postoperative hemorrhage into the abdominal cavity due to inflammatory vessel arrosion represents an uncommon but menacing situation. According to the literature, such hemorrhage is associated with a lethality of nearly 2%. Therapeutical options include reoperation and interventional radiological techniques such as endovascular catheter techniques with stent graft implantation or the embolization of vessels. We report on the management of seven cases with hemorrhage either from the gastroduodenal artery (n=5) following pancreatic surgery for pancreatic carcinoma, liposarcoma, and chronic pancreatitis or from the common hepatic artery (n=1) and the superior mesenteric artery (n=1) following chronic pancreatitis. The present article describes our experiences with stent graft implantation (hemobahn prosthesis) in four cases. Based on these experiences, we see the advantages of stent grafts in primary hemostasis without any contact to infected tissue and the preservation of regular perfusion. However, further clinical data are required focussing on indication, technical success rates, stent-related complications, and long-term outcome.

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Affiliations

  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg

    T. Gebauer, H.-U. Schulz, J. Tautenhahn, Z. Halloul, H. Lippert & T. Bürger

  2. Klinik für Diagnostische Radiologie, Otto-von-Guericke-Universität Magdeburg

    O. Effenberger

  3. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 , Magdeburg

    T. Gebauer

Authors
  1. T. Gebauer
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  2. H.-U. Schulz
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  3. J. Tautenhahn
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  4. Z. Halloul
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  5. O. Effenberger
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  6. H. Lippert
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  7. T. Bürger
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Correspondence to T. Gebauer.

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Gebauer, T., Schulz, HU., Tautenhahn, J. et al. Entzündliche Arrosionsblutungen aus Viszeralarterien. Chirurg 75, 1021–1028 (2004). https://doi.org/10.1007/s00104-004-0834-8

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  • DOI: https://doi.org/10.1007/s00104-004-0834-8

Schlüsselwörter

  • Entzündliche Arrosionsblutung
  • Stentgrafts
  • Hemobahn®-Prothese

Keywords

  • Inflammatory arrosion hemorrhage
  • Stent grafts
  • Hemobahn® prosthesis