Arterial hemorrhage by pseudoaneurysms following pancreatoduodenectomy

Experienced centers report reduced operative mortality after pancreatoduodenectomy for cancer, but significant complications continue to occur in as many as 25% of patients. Anastomotic disruption leads to sepsis in the pancreatic bed where major vascular structures have been exposed by regional lymphadenectomy, creating a setting for arterial erosion or ligature slough and massive hemorrhage. Dehiscence of the pancreatojejunostomy is a particular risk. We presented one patient with arterial hemorrhage from visceral artery pseudoaneurysm after pancreatoduodenectomy, who had had sentinel bleeding from the abdominal drains or gastrointestinal tract. Sentinel bleeding after pancreatoduodenectomy indicates local sepsis and probable anastomotic dehiscence. Recognition of its significance and prompt response may prevent exsanguination.