title: Post-pancreaticoduodenectomy hemorrhage. Incidence, diagnosis, and treatment.
abstract: BACKGROUND
  Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands out; it is associated with high mortality and there is no standard management. The aim of the present study was to analyze the incidence, diagnosis, and treatment of hemorrhage post-cephalic PD at our center.
  
  
  METHODS
  From January 2005 to December 2008, 107 PDs were performed. A retrospective review of characteristics of patients with postoperative hemorrhage was made from our prospective database. Demographic data, diagnosis, treatment (medical, laparotomy, interventional radiology), association with fistula (pancreatic or biliary), intra- or extraluminal hemorrhage, bleeding time (early or late), severity (moderate/severe), and mortality were analyzed.
  
  
  RESULTS
  Eighteen patients (18/107; 16.82%) hemorrhaged after PD. Hemorrhage appeared early (< 24 h) in 4 of these 18 patients (22.2%), and it was severe in 13/18 (72%). Hemorrhage-related mortality was 11% (2/18) and hospital mortality was 22.2% (4/18). Arteriography was performed in 8/18 patients (44.4%) and was effective in 6/8 (75%); laparotomy was performed in 8/18 (44.4%). Re-bleeding occurred in 5 of these 18 patients after the first treatment (27.8%). An association between hemorrhage and fistula was observed.
  
  
  CONCLUSIONS
  Hemorrhage after pancreatic resection must be considered a complication with relatively high mortality. Diagnosis should be established and treatment applied rapidly. Pancreatic and/or biliary fistulae were significantly associated with a higher risk of postoperative hemorrhage. Interventional radiology is a good therapeutic option.
authors: Department of HBP Surgery and Transplant, Hospital Universitari Vall d'Hebrón, Autonomous University of Barcelona, Passeig Vall d'Hebrón 119-129, 08035, Barcelona, Spain. mjmanas@hotmail.com
authors: M J
authors: MJ
authors: Mañas-Gómez
authors: R
authors: R
authors: Rodríguez-Revuelto
authors: J
authors: J
authors: Balsells-Valls
authors: J J
authors: JJ
authors: Olsina-Kissler
authors: M
authors: M
authors: Caralt-Barba
authors: M
authors: M
authors: Pérez-Lafuente
authors: R
authors: R
authors: Charco-Torra
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors