title: Management of postoperative hemorrhage after pancreatoduodenectomy.
abstract: 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.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Yoo-Seok
authors.initials: YS
authors.lastname: Yoon
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.forename: Kyu-Hee
authors.initials: KH
authors.lastname: Her
authors.forename: Yoon-Chan
authors.initials: YC
authors.lastname: Park
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Ahn
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Joon-Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
authors.forename: Yong-Hyun
authors.initials: YH
authors.lastname: Park
mesh_terms: 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