1. Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques.
- Author
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Asai K, Zaydfudim V, Truty M, Reid-Lombardo KM, Kendrick M, Que F, Nagorney D, Andrews J, and Farnell M
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Gastrointestinal Hemorrhage etiology, Humans, Male, Middle Aged, Postoperative Hemorrhage etiology, Retrospective Studies, Time Factors, Treatment Outcome, Endovascular Procedures methods, Gastrointestinal Hemorrhage surgery, Hemostatic Techniques, Pancreaticoduodenectomy adverse effects, Postoperative Hemorrhage surgery
- Abstract
Background: A delayed post-pancreatoduodenectomy haemorrhage is associated with a significant increase in peri-operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short- and long-term outcomes of this approach. A retrospective review over a 10-year period at a quaternary-referral pancreatic centre was performed., Methods: Between 2002-2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post-operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated., Results: A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses., Conclusion: A delayed haemorrhage post-pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non-operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem., (© 2015 International Hepato-Pancreato-Biliary Association.)
- Published
- 2015
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