Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy.

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.