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

Abstract

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.

Keywords: Robotic-assisted pancreatoduodenectomy (RAPD); case report; complication; hemorrhage; intussusception.

Figure 1

Imaging findings. (A) Preoperative computed tomography showed a 17-mm wide low-density area in the uncinate process of the pancreas; (B) magnetic resonance cholangiopancreatography revealed the dilatation of intrahepatic and extrahepatic bile ducts and pancreatic duct.

Figure 2

Intraoperative findings and gastroscopic examination. (A) Intraoperative findings for robotic-assisted pancreatoduodenectomy; (B) gastroscopic examination showed a large amount of hematocele and congestive and edematous intestine in the stomach.

Figure 3

Emergency operation. (A) Output jejunal loop was found intussuscepted in the stomach; (B) long section of small intestine was found inside the stomach.