Emergency Treatments for Haemobilia Associated with Retrograde

Transhepatic Biliary Drainage (RTBD) Following Pancreatoduodenectomy

Abstract

One hundred twenty-five patients underwent pancreatoduodenectomy (PD) over a 22 year period, 6 of whom suffered from pancreatojejunostomy insufficiency following PD. In 1 of the 6 patients, intraabdominalbleeding from rupture of pseudoaneurysm and haemobilia caused by retrograde transhepatic biliary drainage (RTBD) also occurred. Critical hemorrhage could be well managed twice, however, with transcatheterarterial embolization (TAE) procedures. Complete drainage of the intraabdominal cavity and decompressionof the jejunal limb by continuous suction through the RTBD tube were useful for treatment of leakagein the pancreatojejunostomy. In case of bleeding at the abdominal drain or RTBD tube associated withstomal insufficiency, immediate arteriography is important to diagnose the rupture of pseudoaneurysms andto achieve hemostasis by arterial embolization.