Society for Surgery of the Alimentary Tract
Back to 2006 Program and Abstracts
Complications management due to catastrophic endoluminal bleeding after major pancreatic surgery
Guellue Cataldegirmen1, Emre F. Yekebas1, Lars Wolfram1, Dean Bogoevski1, Yogesh Vashist1, Bjoern C. Link1, Oliver Mann1, Lena Liebl1, Gerhard Adam2, Gerrit Krupski2, Jakob R. Izbicki1; 1General, Visceral and Thoracic Surgery, University Clinic Hamburg-Eppendorf, Hamburg, Germany; 2Diagnostic and interventional Radiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany

Background: Here, we report a single institutional experience as to the management of endoluminal bleeding complications originating from the enteropancreatic anastomosis following major pancreatic surgery. Methods: Between 1992 and 2004, 1445 patients were operated on for treatment of pancreatic diseases. Out of these, 1136 patients underwent major pancreatic surgery (492 duodenal preserving pancreas head resections, 311 classic Whipple resections, 146 pylorus preserving pancreato-duodenectomies, 71 distal pancreatectomies, 116 other interventions on pancreas). Results: A severe postoperative endoluminal bleeding (median number of transfused blood units was 9) occurred in 46 patients among whom 24 (52%) had malignant and 22 (48%) had benign diseases. 15 patients (33%) died due to hemorrhage, mostly (n=13) originating from devastating pseudoaneurysms. Out of these patients, 12 patients had malignant diseases and proven pancreatic fistula had developed in 10 cases preceding hemorrhage. Due to the severity of hemorrhage, 9 patients had to be primarily operated. The rest of 37 patients were initially subjected to interventional angiography. From these 37 patients, angiography succeeded in definite treatment in 25 (68%) cases, whereas 12 (32%) patients underwent repeated angiography or had to be secondarily operated under emergency conditions. In 30 patients (81%), in whom angiography succeeded in localizing hemorrhage bleeding sources originated from branches of the common hepatic, splenic, and superior mesenteric arteries. Conclusions: Patients with malignant diseases have a higher risk to develop significant bleeding and have an increased mortality following major pancreatic surgery. Interventional angiography showed good results using the coiling method and therefore should be the method of first choice in severe visceral bleeding.


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Society for Surgery of the Alimentary Tract
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