2019 Volume 44 Issue 2 Pages 286-290
We report a case of early-onset post-pancreatoduodenectomy (PD) hemorrhage (PPH) caused by a pseudoaneurysm, which was successfully treated by transcatheter arterial embolization to avert fatal hemorrhage. A 75-year-old man with bile duct cancer underwent PD. On the second postoperative day (POD), sentinel bleeding occurred from a drain. Emergency abdominal angiography revealed a pseudoaneurysm in the dorsal pancreatic artery, which was embolized using Lipiodol.
A review of 76 cases of PPH reported previously in the Japanese literature revealed that sentinel bleeding occurred in 54%, a concomitant pancreatic fistula was detected in 63%, hemorrhage from around the pancreatic anastomosis was observed in 66%, and a pseudoaneurysm in 70%, respectively. The median interval time from surgery to PPH was 17 POD (range;1-372 POD). The incidence of early-onset PPH within 7 POD was 16 % among the cases for which data were available.
In conclusion, attention should be paid to sentinel bleeding, even if it is of early onset, so as not to miss cases with potentially fatal PPH.
