POST-PANCREATECTOMY HEMORRHAGE

Aim. To analyze incidence, diagnosis and treatment of postpancreatectomy hemorrhage (PPH).

Material and Methods. 318 patients after pancreatectomy were analyzed. There were 223 interventions for pancreatic tumor and 95 cases of chronic pancreatitis. Perioperative care was held by ERAS protocol. PPH occurred in 32 cases (10.1%) including 24 patients with pancreatic tumor and 8 patients with chronic pancreatitis. 5 patients had early PPH, 27 – late bleeding. In 19 cases PPH was intraperitoneal, 11 – intraluminal, combined – 2. Besides clinical examination transabdominal ultrasound, computed tomography and endoscopy were used for diagnosis.

Results. Conservative haemostatic therapy was used in 6 patients. In 17 patients re-laparotomy was done, 3 of them had recurrent PPH subsequently. Endovascular treatment was carried out in 11 cases, 2 of them had previous re-laparotomy. Recurrent PPH after endovascular procedure was observed in 2 cases. 5 patients (15,6%) died.

Conclusion. PPH is the most dangerous complication after pancreatectomy. Instrumental diagnosis and treatment strategy should be used according to patient’s status and severity of PPH. Endovascular procedures are preferred. Re-laparotomy should be done for profuse PPH with hemodynamic instability and for revision after endovascular procedure for intraperitoneal PPH. 

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