DELAYED MASSIVE INTRAPERITONEAL HEMORRHAGE AFTER PANCREATICODUODENECTOMY

Of 144 cases of pancreatoduodenectomy we treated 6 patients (4.2%) wit h delayed massive bleeding. Massive hemorrhage occurred 14 to 38 days later. Leakage of the pancreatojejunostomy was confirmed in all patien ts. A ''sentinel bleed'' was evident in five patients with arterial bl eeding. One patient with hemorrhage of the superior mesenteric vein wa s successfully treated conservatively. One patient with bleeding from the left gastric artery stump survived emergency re-operation. Two of four patients with hemorrhage from the gastraduodenal artery stump wer e successfully treated with selective embolization of the common hepat ic artery. The remaining two patients died of uncontrollable re-bleedi ng or hepatic failure following hemostasis. Angiography and selective embolization are effective for identification and control of the bleed ing site when delayed hemorrhage occurs after pancreatoduodenectomy. I ntensive treatment is necessary to compensate for reduced hepatic arte rial blood supply in cases requiring surgical or radiological interrup tion of the common hepatic artery.