title: Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology.
abstract: OBJECTIVE
  Intra-abdominal arterial hemorrhage is still one of the most serious complications after pancreato-biliary surgery. We retrospectively analyzed our experiences with 15 patients in order to establish a therapeutic strategy for postoperative arterial hemorrhage following pancreato-biliary surgery.
  
  
  METHODS
  Between August 1981 and November 2007, 15 patients developed massive intra-abdominal arterial bleeding after pancreato-biliary surgery. The initial surgery of these 15 patients were pylorus-preserving pancreatoduodenectomy (PPPD) (7 patients), hemihepatectomy and caudate lobectomy with extrahepatic bile duct resection or PPPD (4 patients), Whipple's pancreatoduodenectomy (PD) (3 patients), and total pancreatectomy (1 patient). Twelve patients were managed by transcatheter arterial embolization and three patients underwent re-laparotomy.
  
  
  RESULTS
  Patients were divided into two groups according to the site of bleeding: SMA group, superior mesenteric artery (4 patients); HA group, stump of gastroduodenal artery, right hepatic artery, common hepatic artery, or proper hepatic artery (11 patients). In the SMA group, re-laparotomy and coil embolization for pseudoaneurysm were performed in three and one patients, respectively, but none of the patients survived. In the HA group, all 11 patients were managed by transcatheter arterial embolization. None of four patients who had major hepatectomy with extrahepatic bile duct resection survived. Six of seven patients (85.7%) who had pancreatectomy survived, although hepatic infarction occurred in four.
  
  
  CONCLUSIONS
  Management of postoperative arterial hemorrhage after pancreato-biliary surgery should be done according to the site of bleeding and the initial operative procedure. Careful consideration is required for indication of interventional radiology for bleeding from SMA after pancreatectomy and hepatic artery after major hepatectomy with bilioenteric anastomosis.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Takehide
authors.initials: T
authors.lastname: Asano
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Toyota
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kato
authors.forename: Eriko
authors.initials: E
authors.lastname: Yamazaki
authors.forename: Susumu
authors.initials: S
authors.lastname: Kadowaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Shibuya
authors.forename: Sawako
authors.initials: S
authors.lastname: Maeno
authors.forename: Shigeru
authors.initials: S
authors.lastname: Furui
authors.forename: Koji
authors.initials: K
authors.lastname: Takeshita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kotake
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015641:Radiography, Interventional; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome