Korean J Gastroenterol.  2003 May;41(5):398-405.

Thirty-five Hemorrhagic Complications after Pancreatoduodenectomies

• Moon HJ
• Noh SI
• Heo JS
• Choi SH
• Joh JW
• Kim YI

Abstract

BACKGROUND/AIMS: Mortality following pancreatoduodenectomy has decreased markedly. However, complication rate after pancreatoduodenectomy is still 30-40%. Especially, hemorrhage is the most common cause of mortality. METHODS: From Oct. 1994 to May. 2002, pancreatoduodenectomy was preformed in 454 patients at Samsung Medical Center. The medical records of these patients were reviewed. RESULTS: There were 35 cases of hemorrhage. Among them, 14 cases showed early bleeding within 5 days after operation and 21 cases showed late hemorrhage. In cases of early hemorrhage, type of pancreatoduodenectomy is a critical factor (p=0.040), while in cases of late hemorrhage, the existence of malignancy (p=0.035) and history of intraabdominal complications (p=0.017) are critical factors. Moreover, 17 cases (48.8%) of them were from peripancreatic arteries and 9 cases (25.7%) were from anastomotic site. In 14 cases (40%), operative treatment was carried out firstly and in 10 cases (28.6%), transarterial embolization was selected as a main treatment modality. There were 8 cases of pseudoaneurismal hemorrhage and 3 cases (8.6%) of death. CONCLUSIONS: Hemorrhage after pancreatoduodenectomy is a serious problem resulting in high mortality rate. For prevention and effective treatment of hemorrhagic complications, more meticulous bleeding control during operation and close care after operation are needed. Additionally, intraabdominal local inflammation should be considered as a factor to cause massive late hemorrhage.

Keyword

Pancreaticoduodenectomy; Postoperative complications; Hemorrhage; Aneurysm; false; Embolization; therapeutic

MeSH Terms

Mortality