Pseudoaneurysm of the splenic artery - an uncommon cause of delayed hemorrhage after pancreaticoduodenectomy

Dumitru, Radu; Grasu, Mugur; Toma, Mihai; Ionescu, M; Dumitraşcu, Traian

doi:10.14701/ahbps.2016.20.4.204

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…PPH may originate from the following ( 15): (I) arterial or venous vessels; (II) anastomotic stoma (gastroenteric, jejunojejunal, or pancreaticoenteric); (III) resection areas (e.g., pancreas stump or retroperitoneum); (IV) gastric/duodenal ulcer or diffuse gastritis; (V) eroded and ruptured pseudoaneurysms; or (VI) hemobilia from previously placed endobiliary stents. Dumitru et al reported an uncommon cause of delayed hemorrhage after PD caused by a splenic artery pseudoaneurysm (16). To our knowledge, this is the first case report of output jejunal loop intussusception in the stomach that consequently caused PPH after PD.…”

Section: Discussionmentioning

confidence: 65%

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Zhou¹,

Chen²,

Zou³

et al. 2020

J Gastrointest Oncol

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Post-pancreaticoduodenectomy hemorrhage is a life-threatening complication that occurs in 2-10% of patients. The most common location for post-pancreaticoduodenectomy hemorrhage is the gastroduodenal artery stump. Nonetheless, unusual sources of hemorrhage, which are hard to locate, exist. Here, we report a rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer. A 67-year-old man presenting with appetite loss, general fatigue and painless jaundice was admitted to our ward. The patient had an elevated level of carbohydrate antigen 19-9 (50 U/mL). Computed tomography scan revealed a 17-mm wide low-density area in the uncinate process of the pancreas. Magnetic resonance cholangiopancreatography showed the dilation of bile and pancreatic ducts. Robotic-assisted pancreaticoduodenectomy was performed on the patient by using the da Vinci Model S Surgical System. On postoperative days 5 and 6, the patient vomited blood, and bloody fluid was observed in the drainage. Emergent gastroscopic examination was performed and revealed a large amount of hematocele in the stomach. On postoperative day 6, emergency operation was undertaken, and the output jejunal loop was found to have intussuscepted in the stomach. This is the first case report of output jejunal loop intussusception in the stomach that consequently caused hemorrhage after robotic-assisted pancreaticoduodenectomy for pancreatic head cancer.

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Section: Discussionmentioning

confidence: 65%

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Zhou¹,

Chen²,

Zou³

et al. 2020

J Gastrointest Oncol

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“…In cases of embolization of the hepatic artery, hepatic failure is a major concern. However, if the gastric artery, splenic artery or the jejunal artery is ruptured, in most cases it can be embolized without much significance 22 …”

Section: Discussionmentioning

confidence: 99%

Hepatic artery protection using a polyglycolic acid sheet during pancreaticoduodenectomy: A multicenter study

Lee,

Yoon,

Hong

et al. 2023

J Hepato Biliary Pancreat

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BackgroundPostpancreatectomy hemorrhage (PPH) is the most feared complication after pancreaticoduodenectomy (PD). The most common cause is erosion of the gastroduodenal artery stump. Preventive measures have been previously reported, but a consensus is lacking. The aim of this study was to analyze the preventive effect of reinforcing the hepatic artery using a polyglycolic acid (PGA) sheet during PD.MethodsA multicenter retrospective study was performed, collecting data from three tertiary hospitals in Korea. Patients receiving PD from January 2016 to December 2021 were included. The primary endpoint was rate of PPH from the hepatic artery. Arterial reinforcement (AR) was performed by wrapping the artery with Neoveil (Gunze Ltd) and applying fibrin glue. The perioperative data of patients who did not receive AR were compared with data of those who received AR.ResultsA total of 904 patients were analyzed. The rate of PPH from the hepatic artery was significantly lower in the AR group. (3.5% vs 0.7%, p = .002) In patients with CR‐POPF, the 90 day mortality rate of the AR group was less than half that of the non‐AR group (7.2% vs 3.5%, p = .455) Risk factor analysis showed CR‐POPF to be an independent risk factor for PPH. Arterial reinforcement was shown to be a strong protective factor for PPH (OR 0.20, 95% CI: 0.05–0.72, p = .014).ConclusionsAR of the hepatic artery using Neoveil and fibrin glue is a simple method that greatly reduces the rate of PPH after PD.

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“…Post-operative complications include postoperative pancreatic fistula (POPF), hemorrhage, pseudoaneurysm and arteriovenous fistula. Delayed post-pancreatectomy bleeding refers to the bleeding at >24 h post-PD ( 17 , 23 ). The incidence of post-pancreatectomy bleeding has been estimated to be 4-16% and the mortality rate may be as high as 50% within 1-4 weeks ( 24-26 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of coil embolization in treating pseudoaneurysm post‑Whipple operation

Cong

Zhou

et al. 2020

Exp Ther Med

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The present study aimed to evaluate the clinical efficacy and safety of angiography and coil embolization for pseudoaneurysm post-pancreatoduodenectomy (PD). A total of 17 patients with gastrointestinal or abdominal hemorrhage after PD were included in the present study. Angiography was performed on the celiac artery, common hepatic artery, splenic artery, gastroduodenal artery and superior mesenteric artery to determine the size of the pseudoaneurysm, the parent artery and its collateral branches. A variety of embolization techniques have been applied to embolize pseudoaneurysm, including the sac packing technique, proximal embolization, exclusion technique and sandwich technique. Different techniques with coils were used for embolization and the clinical effects of embolization were analyzed. A total of 18 pseudoaneurysms were identified in 17 patients. In 2 patients, severe technical complications occurred, including migration of the coil and rupture of pseudoaneurysm, and one of them died, which may have been associated with this complication. No serious clinical complications were observed in the other patients. A total of 7 patients had mild clinical complications, including mild abdominal and dorsal pain, which were alleviated after symptomatic management. A total of 15 patients with definite pseudoaneurysm were successfully embolized without re-bleeding and complications. The clinical success rate was 94.1% (16/17). In conclusion, a variety of embolization techniques may be applied for the treatment of pseudoaneurysm after PD, which have high technical and clinical success rates and small trauma. It is recommended in emergency situations, but care should be taken to avoid serious technical complications.

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Pseudoaneurysm of the splenic artery - an uncommon cause of delayed hemorrhage after pancreaticoduodenectomy

Cited by 8 publications

References 24 publications

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Hepatic artery protection using a polyglycolic acid sheet during pancreaticoduodenectomy: A multicenter study

Clinical efficacy of coil embolization in treating pseudoaneurysm post‑Whipple operation

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