Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery

Abstract Background Delayed intraperitoneal hemorrhage (DIH) is still an important cause of postoperative mortality in pancreatic and biliary surgery. Methods Sixty-nine patients who underwent pancreatic and biliary surgery with skeletonization for lymphadenectomy of the hepatoduodenal ligament betw...

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Bibliographic Details
Published in:The American journal of surgery 2007-04, Vol.193 (4), p.454-459
Main Authors: Yamashita, Yo-ichi, M.D., Ph.D, Taketomi, Akinobu, M.D., Ph.D, Fukuzawa, Kengo, M.D., Ph.D, Tsujita, Eiji, M.D, Harimoto, Norifumi, M.D., Ph.D, Kitagawa, Dai, M.D, Kuroda, Yosuke, M.D, Kayashima, Hiroto, M.D, Wakasugi, Kenzo, M.D., Ph.D, Maehara, Yoshihiko, M.D., Ph.D
Format: Article
Language:English
Subjects:
Abdomen
Aged
Biliary Tract Surgical Procedures - adverse effects
Biological and medical sciences
Blood
Delayed intraperitoneal hemorrhage
Digestive System Surgical Procedures - adverse effects
Embolization, Therapeutic
Epidemiology
Female
General aspects
Hemorrhage - etiology
Hemorrhage - therapy
Humans
Intra-abdominal abscess
Male
Medical sciences
Middle Aged
Mortality
Multivariate analysis
Pancreas - surgery
Pancreatic and biliary surgery
Peritoneal Cavity
Pseudoaneurysm
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
Sentinel bleed
Staphylococcus infections
Surgery
Variables
Veins & arteries
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Summary:Abstract Background Delayed intraperitoneal hemorrhage (DIH) is still an important cause of postoperative mortality in pancreatic and biliary surgery. Methods Sixty-nine patients who underwent pancreatic and biliary surgery with skeletonization for lymphadenectomy of the hepatoduodenal ligament between April 2002 and March 2005 were included in this study. Statistical analyses of the risk factors for DIH were performed using both univariate and multivariate modalities. Results DIH occurred in 4 patients (5.8%) within a median time of 15 days after surgery. Stepwise logistic regression analysis identified intra-abdominal abscess formation as the independent predictor of DIH. All 4 patients had a sentinel bleed before the onset of DIH. Three patients were treated by transarterial embolization and 1 patient was treated by surgical intervention. Three patients had liver abscess after hemostasis of DIH, but all 4 patients recovered and were discharged from the hospital. Conclusions A computed tomography angiography should be performed on patients with intra-abdominal abscess formation and sentinel bleed after pancreatic and biliary surgery to check if a pseudoaneurysm has formed.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2006.09.008