Endovascular treatment of delayed hemorrhage developing after the pancreaticoduodenectomy procedure.

Abstract

Delayed hemorrhage after pancreaticoduodenectomy (PD) is still one of the most common causes of mortality. However, the case series regarding interventional treatment of delayed hemorrhage after PD are limited. In this retrospective study, we aimed to evaluate functional outcomes of interventional treatment of late hemorrhages developing after PD. We retrospectively evaluated 16 patients who received endovascular treatment for delayed arterial hemorrhage after PD procedure. Postsurgical nonhemorrhagic complications, time of hemorrhage, site of hemorrhage, endovascular treatment technique, postprocedural complications, and mortality rates were obtained. Mean duration of delayed hemorrhage after PD was 18 days. Computed tomography angiography images for the hemorrhage period were available for 15 patients. We observed extravasation alone in seven patients and pseudoaneurysm alone in five. Pushable coil was used in 15 patients and covered stent in 1. Two patients died due to hepatic failure, and one patient died because of multiple organ dysfunction syndrome (MODS). Delayed hemorrhage after PD is difficult to identify, but accurate and early diagnosis is of vital importance. To date, most appropriate management of this complication remains unclear. Although endovascular treatment techniques may vary for every patient, it is a reliable and effective method for halting hemorrhage. Therefore, interventional procedures must be primarily considered rather than surgical interventions.