Treatment Strategy for Intraperitoneal Bleeding After Pancreatic Resection：From a Surgeon’s Point of View

Abstract

Pancreatectomy is one of the most difficult gastrointestinal surgeries, with a high postoperative complication rate. Among them, hemorrhagic complications are the most serious and can be fatal. Pseudoaneurysm associated with pancreatic fistula is often the source of bleeding, and pancreatic fistula treatment with appropriate drainage management is key to its prevention. Detection of bloody drainage from the drain or gastrointestinal hemorrhage after pancreatic resection should immediately alert the surgeon to the possibility of intraperitoneal bleeding, and a contrast-enhanced CT and angiography should be promptly performed to identify the source of the bleeding. Interventional radiology (IVR) is the treatment of first choice, however, hepatic artery embolization could be complicated by liver dysfunction and abscess formation. For this reason, use of covered stent-grafts, which can stop bleeding while preserving hepatic blood flow, has recently been reported as being useful. However, since IVR is not suitable for some patients, it is essential to select an appropriate treatment method that considers laparotomy.