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A Multimodal Approach Utilizing Balloon Occlusion for Postpancreatectomy Hemorrhage: A Case Report
Aya Maekawa1, Takafumi Sato1, Satoshi Tsuchiya2
1Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Surgical Case Reports
|March 5, 2025
Summary
This case study demonstrates a successful multidisciplinary approach to managing delayed postpancreatectomy hemorrhage (PPH). Temporary common hepatic artery balloon occlusion combined with surgical ligation effectively controlled bleeding while preserving hepatic blood flow.
Area of Science:
- Surgical Oncology
- Interventional Radiology
- Gastroenterology
Background:
- Postpancreatectomy hemorrhage (PPH) is a severe complication after pancreaticoduodenectomy.
- Prompt diagnosis and treatment are crucial for patient survival.
Observation:
- A 79-year-old patient developed delayed PPH on postoperative day 6 after robot-assisted pancreaticoduodenectomy.
- Bleeding originated from the gastroduodenal artery (GDA) stump, complicated by pancreatic fistula and bile leak.
- Standard embolization was deemed risky due to hepatic artery anatomy.
Findings:
- Temporary common hepatic artery (CHA) balloon occlusion stabilized hemodynamics, facilitating surgical intervention.
- Ligation of the GDA stump successfully controlled hemorrhage.
- Choledochojejunostomy leak was repaired, and pancreatic fistula managed conservatively.
- Follow-up imaging confirmed preserved hepatic arterial flow.
Implications:
- A multidisciplinary strategy involving angiography and temporary CHA balloon occlusion is effective for delayed PPH.
- This approach ensures immediate hemostasis and preserves mid-term hepatic blood flow.
- It offers a viable management option for complex postpancreatectomy bleeding.
