title: Pancreatic leak related hemorrhage following pancreaticoduodenectomy. A case series.
abstract: BACKGROUND
  Delayed arterial hemorrhage, secondary to pancreaticojejunal leakage, is an infrequent complication (2-4%) of pancreaticoduodenectomy but it carries a high mortality rate with more than half of the patients dying from overwhelming sepsis and/or bleeding. Its ideal management remains unclear.
  
  
  METHODS
  We hereby present our experience with respect to the presentation and management of this severe post-pancreaticoduodenectomy complication which occurred in 3/149 patients (2.1%) operated on between 1996 and 2008 in our department and we review the role of endoscopy, interventional radiology and surgery in its management.
  
  
  CONCLUSIONS
  The severity of the underlying sepsis and the prompt identification of the sentinel bleed determine surgical and angiographic intervention and define the outcome in the treatment of a pancreatic leak-related hemorrhage. Endoscopy has no role in this setting.
authors.affiliation: Third Surgical Department, G. Genimmatas General Hospital, Athens, Greece. theotsir@med.uoa.gr
authors.forename: Theodoros
authors.initials: T
authors.lastname: Tsirlis
authors.forename: George
authors.initials: G
authors.lastname: Vasiliades
authors.forename: Alexandros
authors.initials: A
authors.lastname: Koliopanos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kopanakis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Katseli
authors.forename: Heracles
authors.initials: H
authors.lastname: Tsipras
authors.forename: Helias
authors.initials: H
authors.lastname: Margaris
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000209:etiology* / Q000378:metabolism; D010189:Pancreatic Juice / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies