Pancreatic leak related hemorrhage following pancreaticoduodenectomy. A case series.
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.
Tsirlis
Theodoros
T
Third Surgical Department, G. Genimmatas General Hospital, Athens, Greece. theotsir@med.uoa.gr
Vasiliades
George
G
Koliopanos
Alexandros
A
Kopanakis
Nikolaos
N
Katseli
Anastasia
A
Tsipras
Heracles
H
Margaris
Helias
H
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