2005 Abstracts: Delayed Visceral Arterial Bleeding After Pancreatic Head Resection
Back to 2005 PostersBack to 2005 Program and Abstracts
Delayed Visceral Arterial Bleeding After Pancreatic Head Resection
Frank Makowiec, University of Freiburg, Germany, Freiburg, Germany, Germany; Hartwig Riediger, Department of Surgery, University of Freiburg, Freiburg, Germany, Germany; Wulf Euringer, Department of Radiology, University of Freiburg, Freiburg, Germany; Mathias Langer, Department of Radiology, University of Freiburg, Freiburg, Germany, Germany; Ulrich T. Hopt, Ulrich Adam, Department of Surgery, University of Freiburg, Freiburg, Germany, Germany
Despite low mortality complications are frequent after pancreatic head resection. The occurrence of delayed visceral arterial bleeding (DVAB) from branches of the celiac trunc or the gastroduodenal artery is rare but lifethreatening and underreported in the literature.
Methods: Since 1994 464 pancreatic head resections were performed. Indications were malignancy (48%), chronic pancreatitis (CP; 47%) or others (5%). DVAB was defined as bleeding from branches of the celiac axis at least one week after surgery. The data were gained from our prospective pancreatic database. The charts of the patients with DVAB were reassessed. We treated 12 patients with DVAB. Three of those had been operated in other hospitals and were referred for bleeding. Results: The frequency of DVAB was 9 of 464 (1.9%) in our patients. It occurred in 0.9% after surgery for CP and in 3.2% in patients with malignancy. In all 12 patients with DVAB bleeding occurred a median of 24 (7–85) days after surgery. Clinical presentation was gastrointestinal (n=7) or abdominal bleeding (n=5). Median number of transfusion was 12.5 (3–37) units. In the 12 patients pancreatic leakage was evident in four. Bleeding sites were the common hepatic (n=5), gastroduodenal (n=5), splenic (n=1) or pancreatoduodenal artery (n=1). Angiography was performed in 10/12 patients and could control bleeding in six (coil-embolization 4, hepatic artery stent 2). One patient died during angiography. In three patients bleeding control was technically not possible, they underwent surgery. Surgical control was obtained in 5 patients (including three after angiography) by ligatures of the common hepatic artery (2), stump of the gastroduodenal artery (2) and splenic artery (1). Of the surviving 11 patients all six with maintained hepatic artery blood flow (including two with stent) had an uneventful further course. After hepatic artery occlusion four of five patients had further complications (three liver abcess, one bile leak). One of the patients with liver abscesses died four months after bleeding control. Conclusion: Delayed visceral arterial bleeding is a rare but severe complication occurring rather late after pancreatic head resection. In the most frequently encountered lesions of the common hepatic artery or the gastroduodenal artery stump bleeding control should optimally been achieved by angiographic stenting since the preservation of hepatic blood flow prevents further severe complications.
Back to 2005 Posters
Back to 2005 Program and Abstracts
