Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery
Yo-ichi Yamashita1, Akinobu Taketomi, Kengo Fukuzawa
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. yamashi@surg2.med.kyushu-u.ac.jp
Background:
Delayed intraperitoneal hemorrhage (DIH) is still an important cause of postoperative mortality in pancreatic and biliary surgery.
Methods:
Sixty-nine patients who underwent pancreatic and biliary surgery with skeletonization for lymphadenectomy of the hepatoduodenal ligament between April 2002 and March 2005 were included in this study. Statistical analyses of the risk factors for DIH were performed using both univariate and multivariate modalities.
Results:
DIH occurred in 4 patients (5.8%) within a median time of 15 days after surgery. Stepwise logistic regression analysis identified intra-abdominal abscess formation as the independent predictor of DIH. All 4 patients had a sentinel bleed before the onset of DIH. Three patients were treated by transarterial embolization and 1 patient was treated by surgical intervention. Three patients had liver abscess after hemostasis of DIH, but all 4 patients recovered and were discharged from the hospital.
Conclusions:
A computed tomography angiography should be performed on patients with intra-abdominal abscess formation and sentinel bleed after pancreatic and biliary surgery to check if a pseudoaneurysm has formed.
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:22Aneurysm IV: Nursing Management
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...