Management of Delayed Post-Pancreaticoduodenectomy Arterial Bleeding: Interventional Radiological Treatment First

Management of a delayed post pancreatoduodenectomy haemorrhage using endovascular techniques

“…Others report simultaneous extra‐ and intra‐luminal bleeding in 7% of cases, which was observed in 12% of our bleeds . Interestingly, in the present study, 17% of the pseudoaneurysms were identified incidentally without overt signs of a haemorrhage.…”

“…8 Others report simultaneous extra-and intra-luminal bleeding in 7% of cases, which was observed in 12% of our bleeds. 9,10 Interestingly, in the present study, 17% of the pseudoaneurysms were identified incidentally without overt signs of a haemorrhage. To our knowledge, this is a novel finding that could be missed by retrospective review of databases for PPH as there may be no clinical signs of a haemorrhage documented.…”

“…A recurrent haemorrhage developed in one of these patients. A completion pancreatectomy has been described in up to 40% of reoperations for haemorrhage; however, it was not performed in either of these cases and is not a preferred approach at our institution …”

Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy: A Case Series of 423 Patients

“…The authors adopted the method of resecting the tissue to the right side of the superior mesenteric artery sheath, including the uncinate process, resulting in elimination of residual postoperative bleeding of the uncinate process. DSA examination and TAE can be used in patients with early PPH in which nonsurgical treatment is ineffective [26]. CTA could help the diagnosis of delayed arterial hemorrhage with a positive rate above 95% [27].…”

Hepaticojejunostomy leak after pancreaticoduodenectomy

“…And after hemostasis, both percutaneous catheter drainage and reoperation with drain replacement were feasible methods to eliminate the cause of bleeding. 16 For HJ-leak associated massive bleedings, we preferred the latter, because the embolization of common hepatic artery would ruin the blood supply of HJ anastomoses which might result in delayed healing, anastomotic stenosis or liver abscess. Placement of Ttube drainage in reoperation could resolve these problems.…”