Evaluation of Surgical and Non-surgical Treatments for Intraperitoneal Hemorrhage after Pancreatoduodenectomy

概要

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Intraperitoneal hemorrhagesp (IPH) is a serious complication after pancreatoduodenectomy (PD) and its treatment strategy is still controversial. This study aimed to evaluate the surgical and nonsurgicaltreatments for IPH after PD. Patients: Of 407 patients who underwent PD, 13 patients (3.2%) whomanifested postoperative IPH were enrolled in this study. Of these, 6 patients suffered from bile ductcarcinoma, 4 had carcinoma of the pancreatic head, and 3 had carcinoma of the papilla Vater. Results: Thebleeding site was confirmed in ten patients and included the pancreatic stump in four, the hepatic artery infour and the superior mesenteric artery in two patients. These were identified intraoperatively in seven, angiographically in two and by autopsy in one patient. Treatments for IPH consisted of surgical treatmentin eight, transcatheter arterial embolization (TAE) in two and conservative treatment in three patients. Two patients in the surgical treatment group (25.0%), both TAE patients (100%) and one of the conservativelytreated patients (33.3%), recovered successfully. Conclusion: The outcome of surgical treatment forIPH was discouraging. TAE, whenever possible, seems to be preferable, as it is more effective in identifyingthe bleeding site and for interventional hemostasis for IPH after PD.
日本腹部救急医学会の論文