Unusual case of digestive bleeding nine months after a cephalic pancreaticoduodenectomy (CPD)
Assamoi Brou Fulgence Kassi1, Jéremie Thereaux2, Bertrand Dousset2
1Service de Chirurgie Digestive, Hepato-Biliaire et Endocrinienne, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Université de Paris Descartes, Paris, France; Division of digestive surgery, University hospital of Cocody-Abidjan, Cote d'Ivoire.
Insights
Delayed post-pancreaticoduodenectomy hemorrhage, often from gastroduodenal artery stump erosion, requires surgical intervention when diagnostic methods fail. This case highlights late presentation and successful surgical management.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Vascular Surgery
Background:
- Hemorrhage after pancreaticoduodenectomy frequently results from gastroduodenal artery stump erosion.
- Diagnostic modalities include endoscopy, angiography, and video capsule endoscopy.
- Surgery is often a last resort due to technical challenges.
Purpose of the Study:
- To report a case of late-onset post-pancreaticoduodenectomy hemorrhage.
- To emphasize the importance of considering secondary arterial erosion in late presentations.
- To highlight the necessity of surgical intervention when diagnostics fail.
Main Methods:
- A 63-year-old female patient presented with recurrent hemorrhage nine months post-cephalic pancreaticoduodenectomy.
- Exploratory laparotomy was performed after a third hemorrhagic episode and failed etiological investigations.
- Bleeding from the gastroduodenal artery stump was identified and surgically treated.
Main Results:
- The patient experienced hemorrhage nine months after pancreaticoduodenectomy.
- Exploratory laparotomy successfully identified and treated gastroduodenal artery stump erosion.
- Surgical intervention was effective despite the late presentation and potential complications.
Conclusions:
- Post-pancreaticoduodenectomy hemorrhage can manifest significantly late.
- Secondary arterial erosion, potentially obscured by liver structures, must be considered.
- Surgical intervention is crucial for managing late-onset hemorrhage despite associated risks.
Introduction:
Post-pancreaticoduodenectomy hemorrhage is mostly due to the gastroduodenal artery stump erosion. The diagnosis of arterial bleeding is done by digestive endoscopy, selective angiography or video capsule endoscopy. On failure of etiological research, surgery is the last resort despite its technical difficulties.
Case Presentation:
A 63 years-old woman was admitted in surgery, nine months after cephalic pancreaticoduodenectomy for a pain of the right hypochondria combined with a pneumoperitoneum, after a 3rd episode of hemorrhage. Exploratory laparotomy is performed after a third hemorrhagic episode and failure of etiological research. Bleeding from the gastroduodenal artery stump was discovered and successfully treated.
Discussion:
Post-pancreaticoduodenectomy hemorrhage can occur very late. In these cases, a secondary arterial erosion obstructed by left hemi-liver should not be excluded. In these cases, despite the technical risks, surgery is required.
Conclusion:
The failure of the means used for diagnostic must lead to the surgery right away, despite operating risk.
