Diagnosis and treatment of post-pancreaticoduodenectomy hemorrhage: a report of 9 cases

Objective:To explore the causes diagnosis,treatment and prevention of haemorrhage after pancreaticoduodenectomy(PD).Methods:The clinical data of 9 patients undergoing PD were retrospectively analyzed.The diagnosis of haemorrhage was made according to the definition and classification of postpancreatectomy haemorrhage(PPH)proposed by the international study group of the pancreatic surgery.Results:Early PPH occurred in 3 cases and delayed PPH in 6 cases;mild PPH was observed in 2 cases and severe PPH in 7 cases including 7 intraluminal PPH and 2 extraluminal PPH;5 patients received reoperation,1 patient emergency selective arterial embolism and 3 patients conservative therapy;2 patients died.Conclusions:Timely operation is essential for management of early PPH;delayed haemorrhage failed by conservative therapy should resort to emergency operation;meticulousoperative techniques,complete hemostasis and effective prevention of postoperative complications such as stomal leak could significantly reduce the occurrence of PPH.Selective arterial embolism might be employed for treatment of delayed hemorrhage.