title: Diagnostic and therapeutic strategies to manage post-pancreaticoduodenectomy hemorrhage.
abstract: OBJECTIVE
  To explore the causes, diagnosis and treatment of post-pancreaticoduodenectomy hemorrhages (PPHs).
  
  
  METHODS
  A database of 703 pancreaticoduodenectomy patients in our institution (January 2008-July 2013) was analyzed retrospectively.
  
  
  RESULTS
  PPHs occurred in 62 patients of which, 38 had clear causes and 15 died because of uncontrolled bleeding and multiple organ failure. Pancreatic fistula and abdominal infection rates were significantly higher in the PPH group compared to the group who did not experience hemorrhages (P < 0.05) but did not significantly increase the mortality of PPH patients. Hemostasis was attempted by endotherapy in 7 patients and was successful in 4 (57.1 %). Angioembolization was performed in 12 patients and was successful in 10 (83.3 %) and relaparotomy in 24 patients successful in 13 (54.2 %). All deceased patients belonged to International Study Group of Pancreatic Surgery clinical grade C and sentinel bleeding occurred in 60 % of PPH mortalities (9/15) (P = 0.005).
  
  
  CONCLUSIONS
  Pancreatic fistulae and abdominal infections are associated with PPH. Control of early mild upper gastrointestinal hemorrhages could be attempted by endotherapy, but angiography with intervention or surgical treatments were always required for delayed bleeding. The mortality in cases with sentinel bleedings was obviously increased.
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, No 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Jian-feng
authors.initials: JF
authors.lastname: Chen
authors.forename: Shi-feng
authors.initials: SF
authors.lastname: Xu
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.forename: Yuan-hu
authors.initials: YH
authors.lastname: Tian
authors.forename: Lin
authors.initials: L
authors.lastname: Gong
authors.forename: Wei-sheng
authors.initials: WS
authors.lastname: Yuan
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001652:Bile Ducts / Q000601:surgery; D004386:Duodenum / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D059413:Intraabdominal Infections / Q000209:etiology; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D013997:Time Factors; D055815:Young Adult