Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques

Kengo Asai, Victor Zaydfudim, Mark Truty, Kmarie Reid-Lombardo, Michael Kendrick, Florencia Que, David Nagorney, James Andrews, Michael Farnell

Research output: Contribution to journalArticle

11 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)902-908
Number of pages7
JournalHPB
Volume17
Issue number10
DOIs
StatePublished - Oct 1 2015

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Asai, K., Zaydfudim, V., Truty, M., Reid-Lombardo, K., Kendrick, M., Que, F., Nagorney, D., Andrews, J., & Farnell, M. (2015). Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques. HPB, 17(10), 902-908. https://doi.org/10.1111/hpb.12464