血管医学および外科ジャーナル

概要

Delayed Post Pancreatectomy Hemorrhage: Incidence, Clinical Characteristics, Risk Factors and Management

A Ben Yehuda, E Nizri, Y Goychman, I Korry, N Lubezky, G Lahat, I Nachmany, J Klausner and M Ben Haim

Background: Delayed Post Pancreatectomy Hemorrhage (DPPH) is a devastating complication of pancreatic surgery, with a mortality rate approaching 50%. Clinical predictors and an effective management modality could improve patient outcome, but currently are not fully established. Aim: To define clinical predictors, treatment modalities and outcomes of DPPH. Methods: We retrospectively evaluated all pancreatic resections conducted in our center during 2008-2013 for delayed PPH. Indications for surgery, operative and post-operative course were reviewed. Methods implied for bleeding control and overall outcome are reported here. Results: Of 403 pancreatic resections performed between 2008-2013, we report 10 cases of severe DPPH (2.5%). Mortality rate was 50%, which yielded 50 % of the overall (90 days) mortality in this cohort. In all cases, pancreatic fistula, sepsis and sentinel bleeding were documented before hemorrhage. CT angiography (CTA) failed to diagnose bleeding or pseudo aneurism in 3 cases. In 8 patients, the intervention to control bleeding was by interventional radiology (IR) (embolization or stenting) without (6/8) or with (2/8) re-laparotomy. IR procedures were performed and successful even in face of hemodynamic instability. Length of hospital stay was increased and patients had high rate of septic episodes. Conclusion: DPPH is a leading cause of mortality in pancreatic surgery. High index of suspicion in the appropriate setting and identification of sentinel bleeding are the keys for diagnosis and early management. IR may be used as both the diagnostic tool and treatment modality even in unstable patients.