Interventional radiology treatment for delayed pancreaticoduodenectomy hemorrhage

Abstract

To evaluate the efficacy and safety of interventional radiology in the treatment for delayed hemorrhage post-pancreaticoduodenectomy. From August 2004 to March 2009, interventional radiology treatments were offered in 18 cases of delayed hemorrhage post-pancreaticoduodenectomy. The patients consisted of 14 males and 4 females with an age range of 23 - 75 years old. There were pancreas carcinoma (n = 8), cystadenoma of pancreas (n = 2), Vater's papilla carcinoma (n = 4) and pancreatitis (n = 4). The interventional radiology treatments included the embolization of splenic artery, the embolization of stump of gastroduodenal artery, the embolization of hepatic artery, transcatheter infusion of vasopressin in the branches of superior mesenteric artery and cover stent placement in hepatic artery. A total of 29 interventional procedures were performed in 18 patients. Hemorrhage was ceased in 16 cases after interventional radiology treatment, no active bleeding was demonstrated and no embolization of assumed site of hemorrhage was performed in 2 cases after diagnostic angiography. Surgery was performed and hemorrhage ceased post-operatively. The average survival time of 18 cases was 18 months (range: 1 week - 50 months). Interventional radiology treatment can be safely and effectively performed in the cases of delayed hemorrhage post-pancreaticoduodenectomy. It should be the first-choice therapy for this medically refractory condition.