Management of postoperative hemorrhage after pancreatoduodenectomy

Abstract

Background/aims: Hemorrhage after pancreatoduodenectomy is a severe, life-threatening complication. This study was conducted to determine the guidelines appropriate for the prevention and management of hemorrhagic complications.

Methodology: We reviewed the medical records of 456 patients who had undergone pancreatoduodenectomy at our hospital between 1991 and 2000.

Results: Significant postoperative bleeding occurred in 21 patients (4.6%). Early bleeding (within the 5th postoperative day) caused by improper intraoperative hemostasis occurred in 5 of these cases; 3 of whom were saved by prompt operation and one by conservative management. The other 16 cases consisted of late bleeding (after the 5th postoperative day), of which 12 patients (75%) experienced pancreatic leaks and 8 pseudoaneurysms of major arteries. "Sentinel bleeding" was evident in 8 cases. Angiographic embolization was performed in 8 cases, 7 of which were successful. Reoperation was tried in 7 cases with complete hemostasis being achieved in 2. As a result, 15 of 21 patients obtained complete hemostasis and the mortality rate from hemorrhage was 28.6% (6/21).

Conclusions: Rapid decision-making is mandatory when bleeding stigmata such as pseudoaneurysm on CT and sentinel bleeding are noted. Prompt operation for early bleeding and angiographic embolization for late bleeding are recommended. In order to prevent hemorrhage after pancreatoduodenectomy, meticulously performed hemostasis and the avoidance of pancreatic anastomotic leaks are essential.