Postoperative arterial hemorrhage after pancreatoduodenectomy: Report of five cases

Abstract

s / Pancreatology 13 (2013) S1–S80 S67 retrospectively analyzed our cases to clarify the effectiveness and limitations on our treatment for the intra-abdominal arterial hemorrhage after PD. Methods: Between March 2000 and April 2013, five of 254 patients (2.0%) developed intra-abdominal hemorrhage in perioperative period after PD. All patients were managed by transcatheter arterial embolization (TAE). The patients can be divided into two groups according to the site of bleeding. Namely, Hepatic Artery (HA) group (4 patients); stump of GDA, RHA and CHA (2patients), and Superior Mesenteric Artery (SMA) group; (1 patient), a branch of jejunal artery of elevated-jejunum for hepaticojejunostomy. Results: All patients had complete hemostasis by single TAE. There was no mortality. The onset of bleeding was on 8th to 14th (median 12th) post-operative day (POD). In 2 of 5 patients, massive bleeding was preceded by minor bleeding 6 to 7 days before. In HA group, 3 patients had past history of upper abdominal surgery (gasterectomy:2, partial resection of duodenectomy:1). In HA group, coil embolization of CHA was performed in all patients. No patients had arterial variation. After embolization the elevation of s-AST/ALT were slight (AST:32-194, ALT:36233) and no hepatic failure was occurred. But liver abscesses were detected in 2 patients 36 and 146 days after embolization. In SMA group the embolization was performed with gelatin, and no complication was observed. The period of hospital stay after TAE was 36 to 146 (median 56) days. Conclusions: Interventional radiology for the arterial hemorrhage after PD was done successfully. A past-history of upper abdominal surgery may be a risk factor of arterial bleeding after PD. In the HA group, it could be useful to employ a metallic covered stent to keep hepatic arterial blood flow and avoid liver abscess formation.