Late post pancreatectomy haemorrhage. Risk factors and modern management

• Published in: Journal of the Pancreas Vol. 11; no. 3; p. 220
• Main Authors: Sanjay, Pandanaboyana, Fawzi, Ali, Fulke, Jennifer L, Kulli, Christoph, Tait, Iain S, Zealley, Iain A, Polignano, Francesco M
• Format: Journal Article
• Language: English
• Published: Italy 05.05.2010
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Aged; Aged, 80 and over; Cholangiocarcinoma - diagnostic imaging; Cholangiocarcinoma - mortality; Cholangiocarcinoma - surgery; Female; Humans; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Neuroendocrine Tumors - diagnostic imaging; Neuroendocrine Tumors - mortality; Neuroendocrine Tumors - surgery; Pancreatic Fistula - mortality; Pancreatic Fistula - therapy; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - statistics & numerical data; Postoperative Hemorrhage - mortality; Postoperative Hemorrhage - therapy; Risk Factors; Scotland - epidemiology; Staphylococcal Infections - mortality; Staphylococcal Infections - therapy; Surgical Wound Infection - mortality; Surgical Wound Infection - therapy; Time Factors; Tomography, X-Ray Computed
• ISSN: 1590-8577; 1590-8577

Current management of late post-pancreatectomy haemorrhage in a university hospital. Haemorrhage after pancreaticoduodenectomy is a serious complication. We report on risk factors and outcome following management by radiological intervention. Tertiary care centre in Scotland. Sixty-seven consecutive patients who underwent pancreaticoduodenectomy. All pancreaticoduodenectomies over a 3-year period were reviewed. International Study Group on Pancreatic Surgery (ISGPS) definition of post-pancreatectomy haemorrhage was used. Endpoints were incidence of haemorrhage, pancreaticojejunal anastomosis leak, methicillin-resistant Staphylococcus aureus (MRSA) infection and mortality. Seven patients (10.4%) developed post-pancreatectomy haemorrhage out of 67 pancreaticoduodenectomies. Median age was 71 years. All post-pancreatectomy haemorrhage were late onset (median 23 days; range: 3-35 days), extraluminal and ISGPS grade C. Post-pancreatectomy haemorrhage arose from hepatic artery (n=4), superior mesenteric artery (n=1), jejunal artery (n=1), and splenic artery (n=1). Angiographic treatment was successful in all patients by embolisation (n=5) or stent grafting (n=2). Pancreatic fistula rate was similar in post-pancreatectomy haemorrhage and "no-haemorrhage" groups (57.1% vs. 40.0%; P=0.440); MRSA infection was significantly higher in post-pancreatectomy haemorrhage group (57.1% vs. 16.7%; P=0.030). Mortality from post-pancreatectomy haemorrhage despite successful haemostasis was 42.9%. Univariate and multivariate analysis identified MRSA infection as a risk factor for post-pancreatectomy haemorrhage. CT angiogram followed by conventional catheter angiography is effective for treatment of late extraluminal post-pancreatectomy haemorrhage. MRSA infection in the abdominal drain fluid increases its risk and therefore aggressive treatment of MRSA and high index of suspicion are indicated.