Konstantinos Alexiou, Argyrios Ioannidis, Ioannis Drikos, Nikolaos Economou
In recent years, even if the associated with pancreaticoduodenectomy mortality has been reduced still remains high. Delayed arterial hemorrhage after pancretoduodenectomy is defined as bleeding 5 or more days postoperatively. Pancreatic fistula and pseudoaneyrysm are the most common complications following pancreaticoduodenectomy and are present in most cases of delayed arterial hemorrhage. Most patients presented to ER with episodes of melena and hematemesis. Upper abdominal control by computer tomography, selective angiography of the celiac trunk and the evaluation of superior mesenteric artery set the diagnosis of pseudoaneurysm of the gastroduodenal of arterial stump. Delayed hemorrhage has more complex pathophysiology and requires a multiple management approaches. In this paper, we review the related to postoperative hemorrhage articles after major pancreatic surgery. Initial management, both diagnostic and therapeutic, should be done by angiographic control and trans-catheter embolization. In case of hemodynamic instability or in cases when angiographic embolism is unsuccessful reoperation is the proper treatment.
