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Pancreatic leak related hemorrhage following pancreaticoduodenectomy. A case series
Theodoros Tsirlis1, George Vasiliades, Alexandros Koliopanos
1Third Surgical Department, G. Genimmatas General Hospital, Athens, Greece. theotsir@med.uoa.gr
Context:
Delayed arterial hemorrhage, secondary to pancreaticojejunal leakage, is an infrequent complication (2-4%) of pancreaticoduodenectomy but it carries a high mortality rate with more than half of the patients dying from overwhelming sepsis and/or bleeding. Its ideal management remains unclear.
Case Reports:
We hereby present our experience with respect to the presentation and management of this severe post-pancreaticoduodenectomy complication which occurred in 3/149 patients (2.1%) operated on between 1996 and 2008 in our department and we review the role of endoscopy, interventional radiology and surgery in its management.
Conclusions:
The severity of the underlying sepsis and the prompt identification of the sentinel bleed determine surgical and angiographic intervention and define the outcome in the treatment of a pancreatic leak-related hemorrhage. Endoscopy has no role in this setting.
