BACKGROUND: The risk of haemorrhage following pancreaticoduodenectomy (PD) is reported as varying between 1.7-20.2%. Embolisation of bleeding vessels is beneficial in the management of HPB trauma although its role in postoperative haemorrhage is unclear. The aim of this study is to document the prevalence of haemorrhagic complications following PD and to evaluate management strategies. METHODS: All patients undergoing PD between 01/03-06/05 were identified from a prospective database. Patients with a post-operative haemorrhage were analysed to determine the presence of risk factors, management and outcome. RESULTS: 107 patients underwent PD and haemorrhagic complications were noted in 15 patients (14%) (6 primary and 9 secondary bleeds). Primary haemorrhages (fall in haemoglobin/blood in drains, no evidence of leaks or sepsis) were noted on days 1-14 and no preoperative risk factors were present. Primary therapy was; 2 patients embolisation (1 proceeding to laparotomy), 3 laparotomy, and 1 conservative. Mortality was 4/6 (1 embolisation and 3 laparotomy including failed embolisation). Patients with secondary haemorrhage presented at a median of 16 days (range: 2-27). All patients had 1 or more risk factors; prior biliary stenting (n=6), bactibilia (n=5), preoperative hyperbilirubinaemia (n=3), postoperative pancreatic (n=4) or biliary leak (n=3), and postoperative sepsis (n=8). All risk factors were more frequent in patients with secondary haemorrhage than in the others undergoing PD. Primary therapy was; 6 embolisation (successful in only 1 case), 5 laparotomy (4 following failed embolisation, 1 failed embolisation was unfit for laparotomy), 2 managed conservatively. Mortality was 4/9 including 3 patients undergoing laparotomy after failed embolisation and 1 patient where embolisation failed but laparotomy was not performed. CONCLUSIONS: Haemorrhage is common following PD and has a high mortality. Embolisation does not appear effective in controlling haemorrhage and might delay definitive management.