Postpancreatectomy hemorrhage (PPH) and pancreatic fistula are main and serious complications following pancreaticoduodenectomy. Postpancreatectomy hemorrhage is considered life-threatening for its high rate of mortality. Postpancreatectomy hemorrhage is defined as early, occurring within 24 h after surgery, and late. The authors present a case of late PPH which developed in the third week following pylorus-preserving pancreaticoduodenectomy. A 58-year-old man was operated on for cancer of the pancreatic head. Hemorrhage occurred when the patient was in full health, convalescing at home. The cause was bleeding from a pseudoaneurysm of the stump of the gastroduodenal artery directly into the gastrointestinal tract. Diagnosis was established based on computed tomography angiography. Treatment was performed using minimally invasive technique during angiography. The implantation of a stent graft into the common hepatic artery for bridging the stump of the gastroduodenal artery was performed. This method thus enabled at once both diagnosis and successful minimally invasive treatment.

Department of Radiology Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Department of Surgery Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Department of Surgery University Hospital Olomouc Czech Republic

Zobrazit více v PubMed

Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5. PubMed

Grützmann R, Rückert F, Hippe-Davies N, et al. Evaluation of the International study group of pancreatic surgery definition of post-pancreatectomy hemorrhage in a high-volume center. Surgery. 2012;151:612–20. PubMed

DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–7. PubMed PMC

Costi R, Randone B, Mal F, et al. Laparoscopic minor pancreatic resections (enucleation/atypical resections). A long-term appraisal of a supposed mini-invasive approach. Videosurgery Miniinv. 2013;8:117–29. PubMed PMC

Tulsyan N, Kashyap VS, Greenberg RK, et al. The endovascular management of visceral artery aneurysma and pseudoaneurysms. J Vasc Surg. 2007;45:276–83. PubMed

Hur S, Yoon CJ, Kang SG, et al. Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques. J Vasc Interv Radiol. 2011;22:294–301. PubMed

Wang MQ, Liu FY, Duan F, et al. Stent-grafts placement for treatment of massive hemorrhagie from ruptured hepatic artery after pancreaticoduodenenctomy. World J Gastroenterol. 2010;16:3716–22. PubMed PMC

Fujii Y, Shimada H, Endo I, et al. Management of massive arterial hemorrhage after pancreatobiliary surgery: does embolotherapy contribute to successful outcome? J Gastrointest Surg. 2007;11:432–8. PubMed PMC

Lee HG, Heo JS, Choi SH, et al. Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy. World J Gastroenterol. 2010;16:1239–44. PubMed PMC

Limongelli P, Khorsandi SE, Pai M, et al. Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis. Arch Surg. 2008;143:1001–7. PubMed

Welsch T, Eisele H, Zschäbitz S, et al. Critical appraisal of the International Study Group of Pancreatic Surgery (ISGPS) consensus definition of postoperative hemorrhage after pancreatoduodenectomy. Langenbecks Arch Surg. 2011;396:783–91. PubMed