[Delayed massive hemorrhage after pancreaticoduodenectomy].
OBJECTIVE
To summarize our clinical experiences of delayed massive hemorrhage (DMH), a rare but fatal complication, after pancreaticoduodenectomy (PD).


METHODS
The clinical data of 14 DMH patients at our medical center were collected and analyzed to evaluate the risk factors and to compare the efficacies of different therapies.


RESULTS
A total of 1008 PD patients were treated since April 1993. Fourteen DMHs occurred post-operatively (1.4%). In these cases, 10/14 (71.4%) were complicated with pancreatic fistula. Sentinel bleeding was observed in 10 (71.4%) cases. The clinical manifestations of DMH included simple abdominal hemorrhage (n = 6, 42.9%), alimentary tract hemorrhage (n = 6, 42.9%) and both (n = 3, 21.4%). Shock (n = 2, 14.3%) might also be the initial symptom. Thirteen cases achieved post-therapeutic hemostasis while 1 patient died before re-admission. The therapeutic modalities included interventional therapy (n = 8) and surgery (n = 5). According to the therapeutic modalities, the re-bleeding rate, morbidity and final mortality of two groups were 50.0% vs 40.0% (P = 0.83), 75.0% vs 60.0% (P = 0.96) and 50.0% vs 80.0% (P = 0.62) respectively. Five patients survived at the end of treatment. The mortality rate was 71.4%.


CONCLUSIONS
As a rare but fatal complication after PD, DMH is difficult to diagnose and treat. Postoperative pancreatic fistula remains a possible but undetermined risk factor. Sentinel bleeding is of great predicative value for DMH. Regular interventional arteriography is an effective method of improving diagnosis and treatment. Both interventional therapy and surgery may be used to treat DMH.
Department of Hepatobiliary Surgery, PLA General Hospital, Beijing 100853 China.
Xiang-fei
XF
Meng
Jing
J
Wang
Zhi-jun
ZJ
Wang
Xiao-qiang
XQ
Huang
Hong-tian
HT
Xia
Jia-hong
JH
Dong
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult