Premium
Management of recurrent bleeding after pancreatoduodenectomy
Author(s) -
Staerkle Ralph F.,
Gundara Justin S.,
Hugh Thomas J.,
Maher Richard,
Steinfort Brendan,
Samra Jaswinder S.
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13976
Subject(s) - medicine , pancreaticoduodenectomy , general surgery , pancreatectomy , interventional radiology , surgery , referral , tertiary referral hospital , radiology , retrospective cohort study , resection , family medicine
Background Re‐bleeding after management of a first haemorrhage following pancreatic surgery is an ever‐present danger and often presents diagnostic and management dilemmas. Methods All cases of post‐pancreatectomy haemorrhage ( PPH ) following pancreatoduodenectomy were identified from a tertiary referral, clinical database (April 2004–April 2013). Only those suffering a second re‐bleeding episode were included in the final case notes review. Results A total of 301 patients underwent pancreatoduodenectomy during the study period (most common indication: pancreatic adenocarcinoma; 49.5%). Twenty‐two (7.3%) patients suffered a PPH (five early). Of these cases, three suffered a re‐bleeding event (one mortality). Endoscopy, interventional radiology and surgery were employed in each case. Conclusion PPH presents major clinical challenges and is associated with significant morbidity and mortality. Early detection of the site and type of bleeding are critical and multimodal therapy is usually required. Interventional radiology techniques are making a major contribution to overall management.