Post-pancreaticoduodenectomy hemorrhage. Incidence, diagnosis, and treatment

M. J. Mañas-Gómez, R. Rodríguez-Revuelto, J. Balsells-Valls, J. J. Olsina-Kissler, M. Caralt-Barba, M. Pérez-Lafuente, R. Charco-Torra

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    Background Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands out; it is associated with high mortality and there is no standard management. The aim of the present study was to analyze the incidence, diagnosis, and treatment of hemorrhage post-cephalic PD at our center. Methods From January 2005 to December 2008, 107 PDs were performed. A retrospective review of characteristics of patients with postoperative hemorrhage was made from our prospective database. Demographic data, diagnosis, treatment (medical, laparotomy, interventional radiology), association with fistula (pancreatic or biliary), intra- or extraluminal hemorrhage, bleeding time (early or late), severity (moderate/severe), and mortality were analyzed. Results Eighteen patients (18/107; 16.82%) hemorrhaged after PD. Hemorrhage appeared early (<24 h) in 4 of these 18 patients (22.2%), and it was severe in 13/18 (72%). Hemorrhage-related mortality was 11% (2/18) and hospital mortality was 22.2% (4/18). Arteriography was performed in 8/18 patients (44.4%) and was effective in 6/8 (75%); laparotomy was performed in 8/18 (44.4%). Re-bleeding occurred in 5 of these 18 patients after the first treatment (27.8%). An association between hemorrhage and fistula was observed. Conclusions Hemorrhage after pancreatic resection must be considered a complication with relatively high mortality. Diagnosis should be established and treatment applied rapidly. Pancreatic and/or biliary fistulae were significantly associated with a higher risk of postoperative hemorrhage. Interventional radiology is a good therapeutic option. © Société Internationale de Chirurgie 2011.
    Original languageEnglish
    Pages (from-to)2543-2548
    JournalWorld Journal of Surgery
    Issue number11
    Publication statusPublished - 1 Nov 2011


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