Delayed hemorrhage after pancreaticoduodenectomy.
BACKGROUND
Postoperative hemorrhage, particularly delayed hemorrhage after pancreaticoduodenectomy, is a serious complication and one of the most common causes of mortality after pancreaticoduodenectomy.


METHODS
The medical records of 500 patients who underwent pancreaticoduodenectomy between October 1994 and December 2002 were analyzed with regard to postoperative hemorrhagic complications. Delayed hemorrhage was defined as bleeding at the operation site after 5 or more postoperative days.


RESULTS
Delayed hemorrhage occurred in 22 patients (4.4%), with a median time of 13 days (range 7 to 32 days) after pancreaticoduodenectomy, and developed more frequently (9/77 versus 13/423, p = 0.003) in patients with preceding intraabdominal complications such as pancreatic fistula, bile fistula, and intraabdominal abscess. In 17 of these 22 patients, angiography and laparotomy revealed bleeding foci at 14 arterial and 3 anastomotic sites. In nine patients, hemorrhage developed from pseudoaneurysms of the major arteries around the pancreaticojejunostomy. Hemostatis was attempted by transcatheter arterial embolization in 14 patients and with laparotomy in 4 patients. Four of 14 patients who received transcatheter arterial embolization eventually required laparotomy. Overall, 4 of the 22 delayed hemorrhage patients died (18.2%) of complications related to massive bleeding or transcatheter arterial embolization.


CONCLUSIONS
Delayed hemorrhage after pancreaticoduodenectomy is associated with a high mortality. Intraabdominal complications after pancreaticoduodenectomy should be evaluated properly and guidelines for the diagnosis and treatment of delayed hemorrhage should be established in advance. Clinicians must be alert to the possibility of pseudoaneurysm hemorrhage.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea South Korea.
Seong Ho
SH
Choi
Hyoun Jong
HJ
Moon
Jin Seok
JS
Heo
Jae Won
JW
Joh
Yong Il
YI
Kim
D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000209:etiology; D004621:Embolization, Therapeutic; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors