Document Detail


Delayed massive arterial hemorrhage after pancreaticoduodenectomy for cancer. Management of a life-threatening complication.
MedLine Citation:
PMID:  14696498     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/AIMS: Delayed massive arterial hemorrhage from the operating field occurs in 1-4% of cases after pancreaticoduodenectomy, with a mortality rate up to 50%. The purpose of this study was to define diagnostic and treatment methodologies to maximize survival. METHODOLOGY: Between 1990 and 1999, 84 pancreaticoduodenectomies were performed for periampullary and pancreatic head cancer. After surgery, massive bleeding occurred in two patients (2.3%), 30 and 8 days after resection, respectively. RESULTS: Pancreatic leak and disruption of the pancreaticojejunostomy were reported in both cases. Bleeding was controlled by suture ligation of the stump of the gastroduodenal artery. Completion pancreatectomy and a new pancreaticojejunostomy were respectively performed. Hemorrhage recurred in both cases from a ruptured pseudoaneurysm of the hepatic artery, requiring re-exploration and surgical ligation. The first patient died of re-bleeding despite completion pancreatectomy, the other survived after oversewing the residual pancreatic stump at re-exploration. CONCLUSIONS: Early diagnosis and management of pancreatic leak represents the only means to prevent a delayed massive arterial hemorrhage. Transarterial embolization or surgical ligation of the hepatic artery proximal to the celiac axis represents the procedure of choice to control the bleeding. Taking down the pancreatic anastomosis and oversewing the pancreatic stump is safe and effective. Extensive drainage of the operating field should always be associated to prevent multisystem organ failure.
Authors:
Roberto Santoro; Massimo Carlini; Fabio Carboni; Christelle Nicolas; Eugenio Santoro
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  50     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2003 Nov-Dec
Date Detail:
Created Date:  2003-12-30     Completed Date:  2004-06-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  2199-204     Citation Subset:  IM    
Affiliation:
Department of Oncological Surgery, Regina Elena Cancer Institute of Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Ampulla of Vater / surgery*
Aneurysm, False / surgery
Aneurysm, Ruptured / surgery
Arteries / surgery
Common Bile Duct Neoplasms / surgery*
Duodenum / blood supply
Fatal Outcome
Female
Hepatic Artery / surgery
Humans
Ligation
Male
Middle Aged
Pancreatectomy
Pancreatic Neoplasms / surgery*
Pancreaticoduodenectomy*
Pancreaticojejunostomy*
Postoperative Hemorrhage / etiology,  surgery*
Recurrence
Reoperation
Stomach / blood supply

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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