Management Of Massive Hemorrhage After Pancreaticoduodenectomy

Objective: To study the management of massive hemorrhage after pancreaticoduodenectomy.Methods:Between January 2005 and June 2015 a total of 48 patients who suffered from post-pancreaticoduodenectomy hemorrhage at our center were analysed.Results:48 patients(13.3%) experienced massive hemorrhage after the surgery. The mortality rate of conservative treatment and reoperation is57.7% and 13.6% respectively( p<0.01). Among gastrointestinal hemorrhage, the mortality rate of conservative treatment and reoperation is53.8% and 12.5% respectively. The mortality rate of conservative treatment and reoperation in operative field hemorrhage is 61.5% and 14.3%respectively. The mortality rate of conservative treatment and reoperation of early hemorrhage is 60.0% and 8.3% respectively. The mortality rate of conservative treatment and reoperation of delayed hemorrhage is 56.3%and 20.0% respectively. In particular, 2 patients(rupture of pseudoaneurysm) stopped bleeding successfully after endovascular embolization, 2 patients(rupture of pseudoaneurysm) dead during reoperation.Conclution : Whether it’s gastrointestinal hemorrhage or operative field hemorrhage, early hemorrhage or late hemorrhage, reoperation is much better than conservative treatment. Endovascular embolization maybe the best treatment when the rupture of pseudoaneurysm happened.