Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed.
OBJECTIVE
To document the prevalence and to evaluate the management strategies of haemorrhagic complications following pancreaticoduodenectomy (PD).


METHODS
All patients who underwent PD from 1/2000 to 10/2005 and experienced at least one episode of haemorrhage during the 30 first days postoperatively were recorded. Etiology of haemorrhage, treatment strategy and mortality rate were recorded and analyzed.


RESULTS
A total of 362 patients underwent PD during this period and 32 (8.8%) had haemorrhage postoperatively of whom 15 died (47% mortality rate). Primary intraluminal haemorrhage was recorded in 13 patients, primary intra-abdominal haemorrhage in 5 patients and secondary haemorrhage in 14 patients. Successful management of haemorrhage with angioembilization occurred in 2 patients in the study group. Statistical analysis revealed sepsis and sentinel bleed as risk factors for post-PD haemorrhage and pancreatic leak and sentinel bleed as risk factors for secondary haemorrhage (p < 0.05).


CONCLUSIONS
Haemorrhage after PD is a life-threatening complication. Sepsis, pancreatic leak, and sentinel bleed are statistical significant factors predicting post-PD haemorrhage. Sentinel bleed is not statistically significant associated with postoperative mortality, but with the onset of secondary haemorrhage. The effectiveness of therapeutic angioembolization was not demonstrated in our study.
Koukoutsis
I
I
Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Bellagamba
R
R
Morris-Stiff
G
G
Wickremesekera
S
S
Coldham
C
C
Wigmore
S J
SJ
Mayer
A D
AD
Mirza
D F
DF
Buckels
J A C
JA
Bramhall
S R
SR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome