Management of life-threatening celiac-hepatic arterial hemorrhage after pancreaticoduodenectomy: usefulness of temporary balloon occlusion.

When a large visceral artery is ruptured, uncontrolled bleeding may lead to hemodynamic collapse. Use of endovascular occlusion balloon catheter may provide rapid control of hemorrhage and facilitate definitive therapy. We reported two patients with massive hemorrhage from ruptured celiac-hepatic artery after pancreaticoduodenectomy, who were initially treated percutaneously by temporary selective balloon occlusion. They became critically hemodynamic unstable during the angiographic procedure. Through an 8Fr sheath, a 6Fr compliant latex occlusion balloon was placed proximal to the celiac trunk and inflated, and upon patient stabilization surgical revision and stent-graft placement were successfully performed in the two patients, respectively. Temporary selective balloon occlusion provides fast and effective bleeding control for patient with critically uncontrollable visceral arterial hemorrhage, permitting subsequent use of conventional techniques for management of the arterial bleeding source.