title: Unusual case of digestive bleeding nine months after a cephalic pancreaticoduodenectomy (CPD).
abstract: BACKGROUND
  Post-pancreaticoduodenectomy hemorrhage is mostly due to the gastroduodenal artery stump erosion. The diagnosis of arterial bleeding is done by digestive endoscopy, selective angiography or video capsule endoscopy. On failure of etiological research, surgery is the last resort despite its technical difficulties.
  
  
  METHODS
  A 63 years-old woman was admitted in surgery, nine months after cephalic pancreaticoduodenectomy for a pain of the right hypochondria combined with a pneumoperitoneum, after a 3rd episode of hemorrhage. Exploratory laparotomy is performed after a third hemorrhagic episode and failure of etiological research. Bleeding from the gastroduodenal artery stump was discovered and successfully treated.
  
  
  CONCLUSIONS
  Post-pancreaticoduodenectomy hemorrhage can occur very late. In these cases, a secondary arterial erosion obstructed by left hemi-liver should not be excluded. In these cases, despite the technical risks, surgery is required.
  
  
  CONCLUSIONS
  The failure of the means used for diagnostic must lead to the surgery right away, despite operating risk.
authors.affiliation: Service de Chirurgie Digestive, Hepato-Biliaire et Endocrinienne, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Université de Paris Descartes, Paris, France; Division of digestive surgery, University hospital of Cocody-Abidjan, Cote d'Ivoire. Electronic address: kassful3@gmail.com.
authors.forename: Assamoi Brou Fulgence
authors.initials: AB
authors.lastname: Kassi
authors.affiliation: Service de Chirurgie Digestive, Hepato-Biliaire et Endocrinienne, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Université de Paris Descartes, Paris, France.
authors.forename: Jéremie
authors.initials: J
authors.lastname: Thereaux
authors.affiliation: Service de Chirurgie Digestive, Hepato-Biliaire et Endocrinienne, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Université de Paris Descartes, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
keywords: Abdominal CT angiography; Arterial bleeding; Gastroduodenal artery stump; Hemorrhage; Post-pancreaticoduodenectomy