title: Haemorrhagic complications of pancreaticoduodenectomy.
abstract: BACKGROUND
  Haemorrhagic complication occurs in 5-16% of patients following pancreaticoduodenectomy (PD). We report an analysis of patients with post-PD bleed, to identify predictors of bleed, predictors of survival following bleed and the management of post-PD bleed.
  
  
  METHODS
  Two hundred and eighteen patients with periampullary cancers underwent PD from 1989 to 2002. Forty-four (20.2%) patients had a bleeding complication. Of these, 25 patients had an intra-abdominal (IA) bleed and 21 had gastrointestinal (GI) bleed (two had both IA and GI bleed). Clinical, biochemical and tumour characteristics were analysed to identify factors influencing bleeding complications.
  
  
  RESULTS
  The median time to presentation was 4.5 days (0-21 days). Serum bilirubin (P = 0.000, OR: 1.090) and pancreaticojejunostomy (PJ) leak (P = 0.009, OR: 3.174) were significant independent factors predicting bleeding complications. Forty-three per cent of patients each had early bleed (<48 h after PD) or delayed bleed (7 days after PD). Comparison of early and late bleeds showed that IA bleed (P = 0.02) presented as early bleeds. Male sex (P = 0.00) longer duration of jaundice (P = 0.02), PJ leak (P = 0.001), HJ leak (P = 0.001), duct to mucosa type of PJ anastomosis (P = 0.03) and IA abscess (P = 0.00) were associated with a significantly higher incidence of late bleeds. Overall mortality after PD was 9.6% with 34% and 3% in bleeders and non-bleeders, respectively. Septicaemia (P = 0.01, OR: 5.49), and acute renal failure (P = 0.01) were associated with increased mortality.
  
  
  CONCLUSIONS
  Bleeding complications following PD were seen in one-fifth of patients and were associated with high mortality. Serum bilirubin levels and PJ leak were significant factors associated with bleeding complications. Septicaemia and acute renal failure were significant factors associated with mortality in the bleeders.
authors.affiliation: Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Palat
authors.initials: P
authors.lastname: Balachandran
authors.forename: Sadiq S
authors.initials: SS
authors.lastname: Sikora
authors.forename: Rachapoodi V
authors.initials: RV
authors.lastname: Raghavendra Rao
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Rajan
authors.initials: R
authors.lastname: Saxena
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Kapoor
mesh_terms: D001663:Bilirubin / Q000097:blood; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001663:Bilirubin