Management of postoperative hemorrhage after pancreatoduodenectomy.
OBJECTIVE
Hemorrhage after pancreatoduodenectomy is a severe, life-threatening complication. This study was conducted to determine the guidelines appropriate for the prevention and management of hemorrhagic complications.


METHODS
We reviewed the medical records of 456 patients who had undergone pancreatoduodenectomy at our hospital between 1991 and 2000.


RESULTS
Significant postoperative bleeding occurred in 21 patients (4.6%). Early bleeding (within the 5th postoperative day) caused by improper intraoperative hemostasis occurred in 5 of these cases; 3 of whom were saved by prompt operation and one by conservative management. The other 16 cases consisted of late bleeding (after the 5th postoperative day), of which 12 patients (75%) experienced pancreatic leaks and 8 pseudoaneurysms of major arteries. "Sentinel bleeding" was evident in 8 cases. Angiographic embolization was performed in 8 cases, 7 of which were successful. Reoperation was tried in 7 cases with complete hemostasis being achieved in 2. As a result, 15 of 21 patients obtained complete hemostasis and the mortality rate from hemorrhage was 28.6% (6/21).


CONCLUSIONS
Rapid decision-making is mandatory when bleeding stigmata such as pseudoaneurysm on CT and sentinel bleeding are noted. Prompt operation for early bleeding and angiographic embolization for late bleeding are recommended. In order to prevent hemorrhage after pancreatoduodenectomy, meticulously performed hemostasis and the avoidance of pancreatic anastomotic leaks are essential.
Yoon
Yoo-Seok
YS
Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Kim
Sun-Whe
SW
Her
Kyu-Hee
KH
Park
Yoon-Chan
YC
Ahn
Young Joon
YJ
Jang
Jin-Young
JY
Park
Sang-Jae
SJ
Suh
Kyung-Suk
KS
Han
Joon-Koo
JK
Lee
Kuhn Uk
KU
Park
Yong-Hyun
YH
D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000401:mortality / Q000601:surgery; D000792:Angiography; D004067:Digestive System Neoplasms / Q000601:surgery; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic; D005260:Female; D006488:Hemostasis, Surgical; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply; D016577:Pancreaticoduodenectomy; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000401:mortality / Q000601:surgery; D015996:Survival Rate