| Late post pancreatectomy haemorrhage. Risk factors and modern management. | |
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MedLine Citation:
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PMID: 20442515 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Pandanaboyana Sanjay; Ali Fawzi; Jennifer L Fulke; Christoph Kulli; Iain S Tait; Iain A Zealley; Francesco M Polignano |
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Publication Detail:
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Type: Journal Article Date: 2010-05-05 |
Journal Detail:
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Title: JOP : Journal of the pancreas Volume: 11 ISSN: 1590-8577 ISO Abbreviation: JOP Publication Date: 2010 |
Date Detail:
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Created Date: 2010-05-05 Completed Date: 2010-07-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101091810 Medline TA: JOP Country: Italy |
Other Details:
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Languages: eng Pagination: 220-5 Citation Subset: IM |
Affiliation:
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Ninewells Hospital and Medical School, Dundee, United Kingdom. f.polignano@nhs.net |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenocarcinoma
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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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