Management of delayed major visceral arterial bleeding after pancreatic surgery
| Autor: | Thomas Pfammatter, Markus Schäfer, Stefan Heinrich, Pierre-Alain Clavien |
|---|---|
| Přispěvatelé: | University of Zurich, Schäfer, M |
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
Time Factors medicine.medical_treatment outcomes Radiography Interventional Pancreatic surgery Bleeding control Recurrence resection intervention Digestive System Surgical Procedures Aged 80 and over medicine.diagnostic_test 10042 Clinic for Diagnostic and Interventional Radiology Gastroenterology Interventional radiology Middle Aged Pancreaticoduodenectomy medicine.anatomical_structure Treatment Outcome Pancreatectomy Female Pancreas Aneurysm False Switzerland Adult Reoperation Aged Aneurysm False/etiology Aneurysm False/mortality Digestive System Surgical Procedures/adverse effects Digestive System Surgical Procedures/mortality Hemostatic Techniques Humans Pancreas/surgery Pancreatectomy/adverse effects Pancreaticoduodenectomy/adverse effects Pancreaticojejunostomy/adverse effects Postoperative Hemorrhage/etiology Postoperative Hemorrhage/mortality Retrospective Studies Tomography X-Ray Computed Viscera/blood supply medicine.medical_specialty 610 Medicine & health Postoperative Hemorrhage Pancreaticojejunostomy medicine 2715 Gastroenterology radiological imaging 10217 Clinic for Visceral and Transplantation Surgery Hepatology business.industry General surgery Retrospective cohort study Original Articles Surgery Viscera 2721 Hepatology Complication business |
| Zdroj: | HPB, vol. 13, no. 2, pp. 132-138 |
| DOI: | 10.5167/uzh-44106 |
| Popis: | ObjectivesPostoperative bleeding represents a life-threatening complication after pancreatic surgery. Recent developments in interventional radiology have challenged the role of surgery in bleeding control. This study aimed to assess the management of major haemorrhagic complications after pancreatic surgery at a tertiary referral centre.MethodsBetween August 1998 and June 2009, 18 patients with major bleeding after pancreatic surgery were admitted to the University Hospital of Zurich, Zurich, Switzerland. We retrospectively analysed their medical charts, focusing on diagnosis, therapy and outcome.ResultsMajor arterial bleeding occurred after a median postoperative interval of 21.5 days (range: 9–259 days). Seventeen patients demonstrated various symptoms, such as repeated upper gastrointestinal bleeding or haemorrhagic shock. Diagnosis was usually made by contrast-enhanced computed tomography (CT). Leakage of the pancreaticojejunostomy caused the formation of a pseudoaneurysm in 78% of patients. Haemostasis was achieved in 10 patients by interventional radiology. Two patients died of massive re-bleeding. Six patients underwent primary emergency surgery, which five did not survive.ConclusionsDelayed bleeding after pancreatic surgery is suspicious for a pseudoaneurysm. Contrast-enhanced CT followed by early angiography provides accurate diagnosis and treatment. Interventional radiological treatment should be preferred over primary surgery because it is currently the most life-saving approach. |
| Databáze: | OpenAIRE |
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