Gastroduodenal artery stump haemorrhage following pylorus-sparing Whipple procedure: treatment with covered stents.
OBJECTIVE
To report a case of bleeding after pancreatoduodenectomy in a patient with pancreatic leak and portal thrombosis who was successfully treated with an endovascular approach.


METHODS
A 58-year-old male, suffering from neoplasm of the distal bile duct, underwent a pylorus-preserving Whipple procedure. On the 18th day, following a sudden drop in pressure and low haematocrit values, the patient underwent surgery. The source of the bleeding was not found. Six days later, following the appearance of bleeding from the abdominal drainage and haematemesis with shock, the patient had an immediate angiography. Bleeding from the gastroduodenal artery stump was evident, the portography showed no portal flow. With respect to the shortness of the stump, safe embolisation with coils, while preserving the common hepatic artery patency, was difficult to obtain.


RESULTS
By transcatheter placement of covered stents into the hepatic artery and thereby occluding the origin of the gastroduodenal artery, the bleeding was stopped. After 2 months, CT angiography showed patency of both the common and proper hepatic arteries. Nine months after the procedure the patient is in good health.


CONCLUSIONS
Percutaneous placement of covered stents can be the solution in cases where transcatheter embolisation is not recommendable because of portal vein thrombosis.
Mansueto
Giancarlo
G
Department of Radiology, University Hospital G.B. Rossi School of Medicine, Verona, Italy. giancarlo.mansueto@univr.it
D'Onofrio
Mirko
M
Iacono
Calogero
C
Rozzanigo
Umberto
U
Serio
Giovanni
G
Procacci
Carlo
C
D000792:Angiography; D001158:Arteries; D001650:Bile Duct Neoplasms / Q000601:surgery; D004386:Duodenum / Q000098:blood supply*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000628:therapy; D015607:Stents; D013270:Stomach / Q000098:blood supply*