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Treatment of Acute Delayed Visceral Hemorrhage After Pancreatic Surgery From Hepatic Arteries with Covered Stents

Journal of Gastrointestinal Surgery volume 15, pages 496–502 (2011)Cite this article

Abstract

Background

Delayed visceral hemorrhage following pancreatic surgery is a rare but life-threatening complication. Usually hemorrhage originates from pseudoaneurysms secondary to pancreatic or biliary fistula. Re-laparotomy is often associated with high morbidity and mortality. Endovascular occlusion with metallic coils can stop pseudoaneurysmatic bleeding, but hepatic artery occlusion can result in severe organ damage. Interventional treatment with covered stents is an alternative providing persistent organ perfusion.

Results

In our department endovascular stenting for visceral hemorrhage was introduced in November 2008. From November 2008 until October 2009, 303 patients underwent pancreatic surgery at our institution. Among those, four patients were successfully treated with covered stents for delayed visceral hemorrhage. In all four patients bleeding originated from hepatic arteries. Mean onset of hemorrhage was 24 days after surgery. Endovascular stenting was successful in all four patients. None of these patients required re-operation or died during the study.

Conclusion

Treatment of delayed visceral hemorrhage from hepatic arteries after pancreatic surgery with covered stents is safe and effective. Endovascular stenting is associated with a lower morbidity than re-laparotomy or coil embolisation. Emergency angiography with endovascular stenting should be considered for all patients with delayed hemorrhage from hepatic arteries after pancreatic surgery.

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Conflicts of Interest

No conflicts of interest are to be stated by the authors. All authors certify that they do not have any commercial association conflicting with the manuscript presented.

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Affiliations

  1. Department of Surgery, St. Josef Hospital, Ruhr-University of Bochum, School of Medicine, Bochum, Germany

    Torsten Herzog, Dominique Suelberg, Orlin Belyaev & Waldemar Uhl

  2. Department of Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr-University of Bochum, Bochum, Germany

    Marcus Seemann

  3. Department of Surgery, Clinics of the Main Taunus-District, Kronbergerstr. 36, 65812, Bad Soden, Germany

    Matthias H. Seelig

Authors
  1. Torsten Herzog
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  2. Dominique Suelberg
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  3. Orlin Belyaev
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  4. Waldemar Uhl
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  5. Marcus Seemann
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  6. Matthias H. Seelig
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Correspondence to Matthias H. Seelig.

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Herzog, T., Suelberg, D., Belyaev, O. et al. Treatment of Acute Delayed Visceral Hemorrhage After Pancreatic Surgery From Hepatic Arteries with Covered Stents. J Gastrointest Surg 15, 496–502 (2011). https://doi.org/10.1007/s11605-010-1260-5

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  • DOI: https://doi.org/10.1007/s11605-010-1260-5

Keywords

  • Hemorrhage
  • Hepatic artery
  • Interventional treatment
  • Covered stent
  • Pancreatic surgery