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Delayed massive intraperitoneal hemorrhage after pancreatoduodenectomy
T Yoshida1, T Matsumoto, Y Morii
1Department of Surgery I, Oita Medical University, Hasama, Japan.
International Surgery
|December 16, 1998
Summary
Delayed massive bleeding after pancreatoduodenectomy, often from pancreatojejunostomy leakage, requires prompt intervention. Angiography and embolization are key for managing arterial bleeding, with careful hepatic artery management crucial for survival.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Interventional Radiology
Background:
- Pancreatoduodenectomy is a complex procedure with potential complications.
- Delayed massive hemorrhage is a rare but serious complication following pancreatoduodenectomy.
Observation:
- Six out of 144 patients (4.2%) experienced delayed massive bleeding 14-38 days post-pancreatoduodenectomy.
- Pancreatojejunostomy leakage was confirmed in all affected patients.
- Sentinel arterial bleeding preceded massive hemorrhage in five patients.
Findings:
- Hemorrhage originated from various arterial stumps (gastroduodenal, left gastric) and the superior mesenteric vein.
- Selective angiography and embolization proved effective in identifying and controlling arterial bleeding sites.
- Conservative management was successful for one superior mesenteric vein hemorrhage case.
- Emergency re-operation saved one patient with left gastric artery stump bleeding.
- Selective embolization of the common hepatic artery was successful in two of four gastroduodenal artery stump hemorrhage cases.
- Two patients died due to uncontrollable re-bleeding or hepatic failure after hemostasis.
Implications:
- Angiography and selective embolization are critical tools for managing delayed post-pancreatoduodenectomy hemorrhage.
- Intensive management is vital to address compromised hepatic arterial blood supply when the common hepatic artery is interrupted.
- Early recognition and intervention can improve outcomes for patients experiencing this severe complication.