title: Clinical features and management of pseudoaneurysmal bleeding after pancreatoduodenectomy.
abstract: A ruptured pseudoaneurysm is the most serious and life-threatening cause of postpancreatoduodenectomy (PD) hemorrhages. We have evaluated the clinical course and management of pseudoaneurysms after PD. Of 586 patients who underwent PD for periampullary tumors in Asan Medical Center  between March 2003 and March 2011, 27 experienced pseudoaneurysmal bleeding. Bleeding developed at a median of 21 days (range, 8 to 45 days) after surgery, including 9 patients who developed bleeding more than 4 weeks after surgery. Before development of bleeding, 26 patients showed pancreatic  fistula. Bleeding was developed from the gastroduodenal artery stump in 12 patients, the common hepatic artery in eight, the proper hepatic artery in five, and the left hepatic artery in two. Of the angiographic group, 21 patients underwent with microcoil embolization, four underwent stent  insertion, and one experienced technical failure. Only one patient required emergent laparotomy without angiography. Of 25 patients with angiographic procedures, all patients achieved hemostasis. The mortality rate was 22.2 per cent (6 patients). Delayed hemorrhage after PD is closely associated  with pancreatic fistula and carried a significantly higher mortality rate. The patients with pancreatic fistula should be carefully monitored, even more than 4 weeks after surgery. Selective microcoil embolization or stent graft is effective for pseudoaneurysmal bleeding.
authors.affiliation: Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Dae Wook
authors.initials: DW
authors.lastname: Hwang
authors.forename: Sang Yeup
authors.initials: SY
authors.lastname: Lee
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Hwang
authors.forename: Dae Keun
authors.initials: DK
authors.lastname: Song
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Kwang-Min
authors.initials: KM
authors.lastname: Park
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000601:surgery*; D000792:Angiography; D004067:Digestive System Neoplasms / Q000150:complications / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D006488:Hemostasis, Surgical; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D012422:Rupture, Spontaneous; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D015996:Survival Rate