title: Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy.
abstract: BACKGROUND
  Hemorrhage after pancreaticoduodenectomy is a life-threatening complication, which occurs in 4% to 16% of cases, even in experienced centers. Many diagnostic and therapeutic options exist but no one has yet established management guidelines. This study aimed to determine the role of conservative management in delayed hemorrhage.
  
  
  METHODS
  From January 2005 to August 2008, 87 patients underwent pancreaticoduodenectomy at our center. We reviewed, retrospectively, the medical charts of all patients who had experienced postoperative hemorrhage.
  
  
  CONCLUSIONS
  Early hemorrhage occurred in one patient, who underwent successful reoperation. Nine patients presented with delayed hemorrhage (10.3%), including three with sentinel bleeding. Mean onset was 20 days post-surgery. We used the same initial management for each patient: all had an urgent contrast computed tomography scan. In every case, the bleeding site was arterial. Conservative treatment (embolization or covered stent) was successful in every case. We reoperated on two patients for gastrointestinal perforation, at 9 days and 2 months after embolization, respectively. We transferred seven patients to an intensive care unit, with an average stay of 8 days. Mean hospital stay was 43 days (33-60). All patients survived.
  
  
  CONCLUSIONS
  Conservative management, combining endovascular procedures and aggressive resuscitation, is appropriate for most cases of delayed hemorrhage after pancreaticoduodenectomy.
authors.affiliation: Department of Digestive Surgery, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la Méditerranée, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer
authors.forename: Rémi
authors.initials: R
authors.lastname: Bonmardion
authors.forename: Sandrine
authors.initials: S
authors.lastname: Marciano
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartung
authors.forename: Olivier
authors.initials: O
authors.lastname: Ramis
authors.forename: Lénaïk
authors.initials: L
authors.lastname: Chabert
authors.forename: Marc
authors.initials: M
authors.lastname: Léone
authors.forename: Olivier
authors.initials: O
authors.lastname: Emungania
authors.forename: Pierre
authors.initials: P
authors.lastname: Orsoni
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
authors.forename: Stéphane V
authors.initials: SV
authors.lastname: Berdah
authors.forename: Christian
authors.initials: C
authors.lastname: Brunet
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome