Results of Non-operative Therapy for Delayed Hemorrhage after Pancreaticoduodenectomy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-05

AUTHORS

Laura Beyer, Rémi Bonmardion, Sandrine Marciano, Olivier Hartung, Olivier Ramis, Lénaïk Chabert, Marc Léone, Olivier Emungania, Pierre Orsoni, Marc Barthet, Stéphane V. Berdah, Christian Brunet, Vincent Moutardier

ABSTRACT

INTRODUCTION: Hemorrhage after pancreaticoduodenectomy is a life-threatening complication, which occurs in 4% to 16% of cases, even in experienced centers. Many diagnostic and therapeutic options exist but no one has yet established management guidelines. This study aimed to determine the role of conservative management in delayed hemorrhage. PATIENTS AND METHODS: From January 2005 to August 2008, 87 patients underwent pancreaticoduodenectomy at our center. We reviewed, retrospectively, the medical charts of all patients who had experienced postoperative hemorrhage. RESULTS AND DISCUSSION: Early hemorrhage occurred in one patient, who underwent successful reoperation. Nine patients presented with delayed hemorrhage (10.3%), including three with sentinel bleeding. Mean onset was 20 days post-surgery. We used the same initial management for each patient: all had an urgent contrast computed tomography scan. In every case, the bleeding site was arterial. Conservative treatment (embolization or covered stent) was successful in every case. We reoperated on two patients for gastrointestinal perforation, at 9 days and 2 months after embolization, respectively. We transferred seven patients to an intensive care unit, with an average stay of 8 days. Mean hospital stay was 43 days (33-60). All patients survived. CONCLUSION: Conservative management, combining endovascular procedures and aggressive resuscitation, is appropriate for most cases of delayed hemorrhage after pancreaticoduodenectomy. More... »

PAGES

922-928

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11605-009-0818-6

DOI

http://dx.doi.org/10.1007/s11605-009-0818-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1040616301

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19224299


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