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

Yamashita, Yo-ichi; Taketomi, Akinobu; Fukuzawa, Kengo; Tsujita, Eiji; Harimoto, Norifumi; Kitagawa, Dai; Kuroda, Yosuke; Kayashima, Hiroto; Wakasugi, Kenzo; Maehara, Yoshihiko

doi:10.1016/j.amjsurg.2006.09.008

« Previous Next »The American Journal of Surgery
Volume 193, Issue 4 , Pages 454-459, April 2007

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

Yo-ichi Yamashita, M.D., Ph.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
- Corresponding author. Tel.: +81-92-642-5469; fax: +81-92-642-5482.
Akinobu Taketomi, M.D., Ph.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Kengo Fukuzawa, M.D., Ph.D.
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
Eiji Tsujita, M.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Norifumi Harimoto, M.D., Ph.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Dai Kitagawa, M.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Yosuke Kuroda, M.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Hiroto Kayashima, M.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Kenzo Wakasugi, M.D., Ph.D.
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
Yoshihiko Maehara, M.D., Ph.D.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

Received 9 January 2006; received in revised form 18 September 2006 published online 17 January 2007.

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.

Keywords: Delayed intraperitoneal hemorrhage, Pseudoaneurysm, Intra-abdominal abscess, Sentinel bleed, Pancreatic and biliary surgery