Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Apr 7;15(13):1625-9.
doi: 10.3748/wjg.15.1625.

Treatment of massive pancreaticojejunal anastomotic hemorrhage after pancreatoduodenectomy

Chen Liu  1 , Ying-He Qiu, Xiang-Ji Luo, Bin Yi, Xiao-Qing Jiang, Wei-Feng Tan, Yong Yu, Meng-Chao Wu
Affiliations

Treatment of massive pancreaticojejunal anastomotic hemorrhage after pancreatoduodenectomy

Chen Liu et al. World J Gastroenterol. .

Abstract

Aim: To compare the treatment modalities for patients with massive pancreaticojejunal anastomotic hemorrhage after pancreatoduodenectomy (PDT).

Methods: A retrospective study was undertaken to compare the outcomes of two major treatment modalities: transcatheter arterial embolization (TAE) and open surgical hemostasis. Seventeen patients with acute massive hemorrhage after PDT were recruited in this study. A comparison of two treatment modalities was based upon the clinicopathological characteristics and hospitalization stay, complications, and patient prognosis of the patients after surgery.

Results: Of the 11 patients with massive hemorrhage after PDT treated with TAE, 1 died after discontinuing treatment, the other 10 stopped bleeding completely without recurrence of hemorrhage. All the 10 patients recovered well and were discharged, with a mean hospital stay of 10.45 d after hemostasis. The patients who underwent TAE twice had a re-operation rate of 18.2% and a mortality rate of 0.9%. Among the six patients who received open surgical hemostasis, two underwent another round of open surgical hemostasis. The mortality was 50%, and the recurrence of hemorrhage was 16.67%, with a mean hospital stay of 39.5 d.

Conclusion: TAE is a safe and effective treatment modality for patients with acute hemorrhage after PDT. Vasography should be performed to locate the bleeding site.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Images from patient 2 (treated using TAE). A: Angiogram of the gastroduodenal stump bleeding before the first embolization. Arrow: Angiogram of the gastroduodenal stump bleeding; B: Angiogram of the gastroduodenal stump, which stopped bleeding after the first TAE. Arrow: Angiogram of the gastroduodenal stump); C: Angiogram of the stump prior to the second embolization. Angiography indicates that microcoils have entered the hepatic artery, causing renewed bleeding from the stump. Arrows: The second angiogram of the gastroduodenal stump bleeding; D: After the second embolization, angiography confirmed that the bleeding was stopped. Arrow: Angiogram of the gastroduodenal stump.
See this image and copyright information in PMC

Comment in

References

    1. Yoon YS, Kim SW, Her KH, Park YC, Ahn YJ, Jang JY, Park SJ, Suh KS, Han JK, Lee KU, et al. Management of postoperative hemorrhage after pancreatoduodenectomy. Hepatogastroenterology. 2003;50:2208–2212. - PubMed
    1. Mao QS, Zhou XZ, Zan ZZ, Chen SZ. The currelation between pancreatic fistula and the methods of pancreatoenterostomy after pancreatoduodenectomy. Hebei Yixue. 2002;8:797–780.
    1. Du ZG, Li B, Feng X, Yin J, Yan LN, Wen TF, Zeng Y. Cause and treatment of upper gastrointestinal hemorrhage after pancreatoduodenectomy. Zhongguo Puwai Jichu Yu Linchuang Zazhi. 2008;15:511–513.
    1. Wu GZ, Liu HA, Jiang J, Cao XC. Prevention of pancreatic fistula afar pancreaticoduodenectomy using complete external drainage of pancreatic fluid. Zhongguo Xiandai Shoushu Zazhi. 2005;9:225–227.
    1. Blanc T, Cortes A, Goere D, Sibert A, Pessaux P, Belghiti J, Sauvanet A. Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated? Am J Surg. 2007;194:3–9. - PubMed