Therapeutic strategies for pancreatic pseudoaneurysm after surgery

Abstract

Background：The strategies for pseudoaneurysms after pancreatectomy are being established. However, the measures are still extremely important.Methods：A total of 268 pancreatectomies （pancreaticoduodenectomy, n＝196 and distal pancreatectomy, n＝72） performed in our department from April 2011 to March 2019 were retrospectively examined for the results of treatment for pseudoaneurysms.Results：Out of 268 cases, the pseudoaneurysms were observed in 8 cases （3.0％）. Arterial embolization was performed in 7 cases. Two cases required laparotomy for stopping bleeding, but one of them died. The pseudoaneurysms were detected by dynamic CT on day 7 after surgery （3 cases）, sentinel bleeding （3 cases）, bloody bowel discharge （1 case） and hemorrhagic shock （1 case）, and the median period to identify them was 18 （7-71, range） days. Bacteria were detected by drain culture on day 3 after surgery in 5 cases, and intraperitoneal drain was replaced in 7 cases at the time of identification of pseudoaneurysms.Conclusions：Dynamic CT on day 7 after pancreatectomy are useful for searching for the pseudoaneurysms. Patients with early infection of drain discharge have a high risk of pseudoaneurysm development after pancreatectomy.