Cause and treatment of gastrointestinal hemorrhage after pancreaticoduodenectomy

Abstract

Objective To analyze the cause and treatment of the postoperative gastrointestinal hemorrhage after pancreaticoduodenectomy(PD).Methods Clinical data of 213 patients who underwent PD in our hospital from January 1996 to December 2011 and 2 patients who suffered from gastrointestinal hemorrhage after PD transferred to our hospital from other hospitals were retrospectively analyzed.Results The incidence of postoperative gastrointestinal hemorrhage was 8.5％ (18/213),the mortality rate of which was 22.2％ (4/18).Among the twenty patients with postoperative gastrointestinal hemorrhage (including the 2 patients transferred from other hospitals),stress ulcer was the most common reason of gastrointestinal hemorrhage (11/20,55 ％).There were 8 patients suffering from mild hemorrhage who were treated by medications.Seven of 12 patients who suffered from severe hemorrhage underwent reoperation.Univariate analysis showed that duration of operation above 420 min (x2 =3.976,P =0.046) and volume of intraoperative blood loss above 1200 ml (x2 =6.753,P =0.009) were significantly associated with postoperative stress ulcer bleeding.Multivariate logistic regression analysis showed that intraoperative blood loss was the only independent factor associated with postoperative stress ulcer bleeding (OR =5.677,P =0.035).Conclusion Gastrointestinal hemorrhage is one of the common complications after PD.The incidence of stress ulcer bleeding could be reduced by skillful operation and decreasing intraoperative blood loss.Operation should be used properly according to the cause and location of bleeding if hemorrhage could not be stopped by medications. Key words: Pancreaticoduodenectomy; Gastrointestinal hemorrhage; Stress ulcer