Successful Hemostasis of Post-pancreaticoduodenectomy Arterial Bleeding by Placement of a Covered Stent for Coronary Arteries

Abstract

Bleeding from a pseudoaneurysm after pancreaticoduodenectomy (PD) is one of the fatal complications of this procedure. Bleeding frequently occurs from the stump of the resected gastroduodenal artery, and first line treatment is transcatheter embolization of the hepatic artery, but with the interruption of blood flow through the hepatic artery, there is a risk of liver failure and liver abscess. In recent years, covered stents, which allow for hemostasis while maintaining hepatic blood flow, have come into use.

In this case, upon identifying sentinel bleeding from a pancreatic fistula after PD, we placed a covered stent in the common hepatic artery, which we believe prevented massive hemorrhage. We think that anticipation of arterial rupture upon detecting the pancreatic fistula, frequent evaluation of the patient and monitoring of the drain, and close communication with the interventionalist performing catheterization were crucial to favorable outcome in this case.