title: [The diagnosis and management strategies for gastrointestinal hemorrhage following pancreaticoduodenectomy].
abstract: OBJECTIVE
  To analyze the causes and clinical features of gastrointestinal hemorrhage following pancreaticoduodenectomy (PD), and to provide the management strategies for this complication.
  
  
  METHODS
  The clinic data of 412 patients who underwent PD from January 2000 to April 2010 was retrospectively reviewed. There were 232 male and 180 female patients, average age was (60 ± 12) years. The mode of procedure was standard PD and the Child's reconstruction of digestive tract, whose anastomosic steps encluded gastroenterostomy following chlangioenterostomy and pancreaticoenterostomy, was employed. Etiology of gastrointestinal haemorrhage, diagnostic methods and treatment strategy was recorded and analyzed.
  
  
  RESULTS
  The postoperative mobidity was 37.1% (153/412), the rate of haemorrhagic complications was 6.6% (27/412), and gastrointestinal hemorrhage was recorded in 11 patients (2.7%). The bleeding rate of pancreaticointestinal anastomosis and gastricointestinal anastomosis were 5/11 and 4/11, respectively. Among these 11 patients, early hemorrhage occurred in 6 patients, 7 patients were due to technical failure. In order to control this kind of complication, open abdominal operation alone was performed on 4 patients, endoscopic management was performed on 3 patients and succeeded in 2 patients, vascular interventional therapy was performed on 5 patients and succeeded in 2 patients, and Re-laparotomy following vascular interventional therapy was performed on 2 patients successfully.
  
  
  CONCLUSIONS
  Gastrointestinal hemorrhage following PD always occurred in early stage and reliable hemostasis during operation is the key points for prevention. Angiography is minimally invasive and holds the diagnostic value. Timely and decisive reoperation is an important method to management of postoperative gastrointestinal hemorrhage.
authors.affiliation: Department of General Surgery, Peking University First Hospital, Beijing 100034, China.
authors.forename: Hong-qiao
authors.initials: HQ
authors.lastname: Gao
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhuang
authors.forename: Xiao-dong
authors.initials: XD
authors.lastname: Tian
authors.forename: Guang-dong
authors.initials: GD
authors.lastname: Wu
authors.forename: Yin-mo
authors.initials: YM
authors.lastname: Yang
mesh_terms: D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome