title: Management of delayed post-pancreaticoduodenectomy arterial bleeding: interventional radiological treatment first.
abstract: OBJECTIVE
  To investigate the diagnosis and treatment of delayed post-pancreaticoduodenectomy arterial bleeding (DPPAB).
  
  
  METHODS
  Records of 336 patients who underwent pancreaticoduodenectomy (PD) between January 2000 and December 2010 were retrospectively analyzed. Detailed data of patients with DPPAB were assessed by a thorough review of medical records.
  
  
  RESULTS
  14 patients developed DPPAB. The mean time interval between the initial surgery and DPPAB was 33 days (range 7-72). Three patients experienced sentinel bleeding 5-8 days before DPPAB. All DPPAB patients had intra-abdominal septic complications before bleeding. The overall prevalence of success of angiography and transcatheter arterial embolization (TAE) was 85.7% (12/14), including 3 patients who achieved complete hemostasis by TAE after unsuccessful re-laparotomy. The prevalence of mortality of DPPAB was 28.6% (4/14). After hemostasis was achieved, intra-abdominal septic complications were controlled by percutaneous catheter drainage or re-laparotomy with drain replacement.
  
  
  CONCLUSIONS
  Angiography and TAE are recommended as the first-line diagnostic and treatment choice for DPPAB, respectively. Surgical intervention should be preserved to eliminate the cause of bleeding.
authors.affiliation: Department of Hepatopancreatobiliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China.
authors.forename: Ji
authors.initials: J
authors.lastname: Zhang
authors.forename: Xu
authors.initials: X
authors.lastname: Zhu
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Hong-Gang
authors.initials: HG
authors.lastname: Qian
authors.forename: Jia-Hua
authors.initials: JH
authors.lastname: Leng
authors.forename: Hui
authors.initials: H
authors.lastname: Qiu
authors.forename: Jian-Hui
authors.initials: JH
authors.lastname: Wu
authors.forename: Bo-Nan
authors.initials: BN
authors.lastname: Liu
authors.forename: Qiao
authors.initials: Q
authors.lastname: Liu
authors.forename: Ang
authors.initials: A
authors.lastname: Lv
authors.forename: Ying-Jie
authors.initials: YJ
authors.lastname: Li
authors.forename: Guo-Quan
authors.initials: GQ
authors.lastname: Zhou
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Hao
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy; D011859:Radiography; D015642:Radiology, Interventional; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy; D015607:Stents; D013530:Surgical Wound Infection / Q000628:therapy