Joseph R Habib1, Shanshan Gao1, Ahn Joon Young2, Elie Ghabi1, Aslam Ejaz3, William Burns1, Richard Burkhart1, Matthew Weiss4, Christopher L Wolfgang5, John L Cameron1, Robert Liddell6, Christos Georgiades6, Kelvin Hong6, Jin He7, Kelly J Lafaro8. 1. Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA. 2. Department of Surgery, SNMU, Seoul, South Korea. 3. Department of Surgery, OSU, Columbus, OH, USA. 4. Department of Surgery, Northwell Health, Manhasset, NY, USA. 5. Department of Surgery, NYU Langone Health, New York, NY, USA. 6. Division of Interventional Radiology, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 7. Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA. jhe11@jhmi.edu. 8. Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA. klafaro1@jhmi.edu.
Abstract
BACKGROUND: Delayed bleeding after pancreaticoduodenectomy (PD) is a life-threatening complication. However, the optimal management remains unclear. We summarize our experience of the management of delayed bleeding after PD and define the outcomes associated with different types of management. METHODS: All patients who underwent a PD between January 1987 and June 2020 at Johns Hopkins University were retrospectively reviewed. Delayed bleeding was defined as bleeding on or after postoperative day 5 following PD. Incidence, outcomes, and trends were reported. RESULTS: Among the 6201 patients that underwent PD, delayed bleeding occurred in 130 (2.1%) at a median of 12 days (IQR: 9, 24) postoperation. The pattern of bleeding was classified as intraluminal (51.5%), extraluminal (40.8%), and mixed (7.7%). A clinically relevant postoperative pancreatic fistula and an intraabdominal abscess preceded the delayed bleeding in 43.1% and 31.5% of cases, respectively. Arterial pseudoaneurysm or bleeding from peripancreatic vessels was the most common reason (54.6%) with the gastroduodenal artery being the most common source (18.5%). Endoscopy, angiography, and reoperation were performed as a first-line approach in 35.4%, 52.3%, and 6.2% of patients, respectively. The overall mortality was 16.2% and decreased over the study period (p < 0.01). CONCLUSIONS: Delayed bleeding following PD remains a life-threatening complication. The most common location of delayed bleeding is from the gastroduodenal artery. Angiography with embolization should be the initial approach for urgent bleeding with surgical re-exploration reserved for unstable patients or failed control of bleeding after interventional angiography or endoscopy.
BACKGROUND: Delayed bleeding after pancreaticoduodenectomy (PD) is a life-threatening complication. However, the optimal management remains unclear. We summarize our experience of the management of delayed bleeding after PD and define the outcomes associated with different types of management. METHODS: All patients who underwent a PD between January 1987 and June 2020 at Johns Hopkins University were retrospectively reviewed. Delayed bleeding was defined as bleeding on or after postoperative day 5 following PD. Incidence, outcomes, and trends were reported. RESULTS: Among the 6201 patients that underwent PD, delayed bleeding occurred in 130 (2.1%) at a median of 12 days (IQR: 9, 24) postoperation. The pattern of bleeding was classified as intraluminal (51.5%), extraluminal (40.8%), and mixed (7.7%). A clinically relevant postoperative pancreatic fistula and an intraabdominal abscess preceded the delayed bleeding in 43.1% and 31.5% of cases, respectively. Arterial pseudoaneurysm or bleeding from peripancreatic vessels was the most common reason (54.6%) with the gastroduodenal artery being the most common source (18.5%). Endoscopy, angiography, and reoperation were performed as a first-line approach in 35.4%, 52.3%, and 6.2% of patients, respectively. The overall mortality was 16.2% and decreased over the study period (p < 0.01). CONCLUSIONS: Delayed bleeding following PD remains a life-threatening complication. The most common location of delayed bleeding is from the gastroduodenal artery. Angiography with embolization should be the initial approach for urgent bleeding with surgical re-exploration reserved for unstable patients or failed control of bleeding after interventional angiography or endoscopy.
Authors: Bhavraj S Khalsa; David K Imagawa; Joseph I Chen; Aram N Dermirjian; Douglas B Yim; Laura K Findeiss Journal: Pancreas Date: 2015-08 Impact factor: 3.327
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Authors: Joseph A Miccio; Wesley J Talcott; Timil Patel; Henry S Park; Michael Cecchini; Ronald R Salem; Sajid A Khan; Stacey Stein; Jeremy S Kortmansky; Jill Lacy; Amol Narang; Joseph Herman; Salma K Jabbour; Christopher L Hallemeier; Kimberly Johung; Krishan R Jethwa Journal: Clin Transl Radiat Oncol Date: 2020-12-16