title: Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed.
abstract: 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.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
authors.forename: I
authors.initials: I
authors.lastname: Koukoutsis
authors.forename: R
authors.initials: R
authors.lastname: Bellagamba
authors.forename: G
authors.initials: G
authors.lastname: Morris-Stiff
authors.forename: S
authors.initials: S
authors.lastname: Wickremesekera
authors.forename: C
authors.initials: C
authors.lastname: Coldham
authors.forename: S J
authors.initials: SJ
authors.lastname: Wigmore
authors.forename: A D
authors.initials: AD
authors.lastname: Mayer
authors.forename: D F
authors.initials: DF
authors.lastname: Mirza
authors.forename: J A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: S R
authors.initials: SR
authors.lastname: Bramhall
mesh_terms: 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