Treatment of massive pancreaticojejunal anastomotic hemorrhage after pancreatoduodenectomy

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.

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.