Post pancreatic surgery hemorrhage: management and outcome

Abstract

Background: Postoperative hemorrhage after pancreatic surgery is a serious complication. This study analyzed clinical presentation, risk factors and management of post pancreatic surgery hemorrhage to determine the role of angioembolization and surgery.

Methods: 536 patients who underwent pancreatic surgery from 2003 to 2009 were studied with regard to postoperative hemorrhage. The severity of bleeding (mild, moderate and severe) and presentation (early, delayed) was defined as per guidelines of international study group of pancreatic surgery definition. Associated postoperative complications, diagnostic workup, interventions done and their outcomes were analyzed.

Results: 24 out of 536 (4.47%) had post pancreatic surgery hemorrhage. 17 were male and 7 were female. Mean age of the patients was 48.87 (Range 17-78 years). Of these 24 patients 13 (54.16%) had underwent Whipple’s procedure, 9 (37.5%), Frey’s operation, 1 (4.16 %) enucleation of insulinoma and 1 (4.16%) median pancreatectomy.  4 patients presented as early hemorrhage, delayed presentation was in 20 patients. Extraluminal hemorrhage was present in 8 patients, 13 patients manifested as intraluminal hemorrhage whereas combined extra and intraluminal hemorrhage was present in 3 cases. Conservative management was done in 7 patients, 13 patients required angiography and surgical management was done in 8 patients. There were 4 deaths; rest 20 patients were managed successfully.

Conclusions: Hemorrhage after pancreatic surgery occurred in 4.47% of cases.  Early hemorrhage is usually due to failure of primary hemostasis.  Postoperative pancreatic fistula is the main risk factor for delayed postoperative hemorrhage. Angiographic embolization was the procedure of choice for controlling delayed bleeding. Both surgery and angiography had role in post pancreatectomy hemorrhage.