Document Detail


Late post pancreatectomy haemorrhage. Risk factors and modern management.
MedLine Citation:
PMID:  20442515     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Current management of late post-pancreatectomy haemorrhage in a university hospital. OBJECTIVE: Haemorrhage after pancreaticoduodenectomy is a serious complication. We report on risk factors and outcome following management by radiological intervention. SETTING: Tertiary care centre in Scotland. SUBJECTS: Sixty-seven consecutive patients who underwent pancreaticoduodenectomy. METHODS: All pancreaticoduodenectomies over a 3-year period were reviewed. International Study Group on Pancreatic Surgery (ISGPS) definition of post-pancreatectomy haemorrhage was used. MAIN OUTCOME MEASURES: Endpoints were incidence of haemorrhage, pancreaticojejunal anastomosis leak, methicillin-resistant Staphylococcus aureus (MRSA) infection and mortality. RESULTS: Seven patients (10.4%) developed post-pancreatectomy haemorrhage out of 67 pancreaticoduodenectomies. Median age was 71 years. All post-pancreatectomy haemorrhage were late onset (median 23 days; range: 3-35 days), extraluminal and ISGPS grade C. Post-pancreatectomy haemorrhage arose from hepatic artery (n=4), superior mesenteric artery (n=1), jejunal artery (n=1), and splenic artery (n=1). Angiographic treatment was successful in all patients by embolisation (n=5) or stent grafting (n=2). Pancreatic fistula rate was similar in post-pancreatectomy haemorrhage and "no-haemorrhage" groups (57.1% vs. 40.0%; P=0.440); MRSA infection was significantly higher in post-pancreatectomy haemorrhage group (57.1% vs. 16.7%; P=0.030). Mortality from post-pancreatectomy haemorrhage despite successful haemostasis was 42.9%. Univariate and multivariate analysis identified MRSA infection as a risk factor for post-pancreatectomy haemorrhage. CONCLUSION: CT angiogram followed by conventional catheter angiography is effective for treatment of late extraluminal post-pancreatectomy haemorrhage. MRSA infection in the abdominal drain fluid increases its risk and therefore aggressive treatment of MRSA and high index of suspicion are indicated.
Authors:
Pandanaboyana Sanjay; Ali Fawzi; Jennifer L Fulke; Christoph Kulli; Iain S Tait; Iain A Zealley; Francesco M Polignano
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Publication Detail:
Type:  Journal Article     Date:  2010-05-05
Journal Detail:
Title:  JOP : Journal of the pancreas     Volume:  11     ISSN:  1590-8577     ISO Abbreviation:  JOP     Publication Date:  2010  
Date Detail:
Created Date:  2010-05-05     Completed Date:  2010-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101091810     Medline TA:  JOP     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  220-5     Citation Subset:  IM    
Affiliation:
Ninewells Hospital and Medical School, Dundee, United Kingdom. f.polignano@nhs.net
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / mortality*,  radiography,  surgery*
Aged
Aged, 80 and over
Cholangiocarcinoma / mortality,  radiography,  surgery
Female
Humans
Logistic Models
Male
Methicillin-Resistant Staphylococcus aureus
Middle Aged
Neuroendocrine Tumors / mortality,  radiography,  surgery
Pancreatic Fistula / mortality,  therapy
Pancreatic Neoplasms / mortality*,  radiography,  surgery*
Pancreaticoduodenectomy / adverse effects*,  statistics & numerical data
Postoperative Hemorrhage / mortality*,  therapy*
Risk Factors
Scotland / epidemiology
Staphylococcal Infections / mortality,  therapy
Surgical Wound Infection / mortality,  therapy
Time Factors
Tomography, X-Ray Computed

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


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