title: Post-pancreaticoduodenectomy hemorrhage of unusual origin: treatment with endovascular embolization and the value of preoperative CT angiography.
abstract: Post-pancreaticoduodenectomy hemorrhage is a life threatening complication reported to occur in 2-7% of patients. Historically, treatment required an exploratory laparotomy. Introduction of endovascular embolization has broadened the available treatment options. The most common location for a post-pancreaticoduodenectomy hemorrhage is the gastroduodenal artery stump. Nonetheless, unusual sources of hemorrhage exist and are hard to localize, thus they are often treated with open surgery. Here we report two cases of CTA proven hemorrhage from the dorsal pancreatic arcade and transverse pancreatic artery, which were successfully located with conventional angiography and treated with endovascular arterial coil embolization. Both patients were status post-pancreaticoduodenectomy (Whipple procedure) and presented with a sentinel bleed and a drop in hematocrit levels.
authors.affiliation: Department of Radiology, Upstate University Hospital, Syracuse, NY, USA.
authors.forename: Kortney
authors.initials: K
authors.lastname: Robinson
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Rajebi
authors.forename: Nicole
authors.initials: N
authors.lastname: Zimmerman
authors.forename: Chadi
authors.initials: C
authors.lastname: Zeinati
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging; D000792:Angiography; D004621:Embolization, Therapeutic; D006801:Humans; D008297:Male; D010179:Pancreas / Q000098:blood supply; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed
keywords: Angiography; Computed Tomography; coil embolization; endovascular procedure; pseudoaneurysm