Abstract
Objective: To evaluate the efficacy of early angiography in the diagnosis and treatment of delayed arterial hemorrhage as a significant complication following pancreatectomy. Design: Retrospective case series. Setting: University hospital; 6-year period between January 1992 and December 1997. Patients and Intervention: Of a total of 81 patients undergoing pancreatic head resection, 10 (12%) developed massive arterial hemorrhage after surgery. All 10 patients underwent an emergency angiography and 8 of these were managed by transcatheter arterial embolization. Results: Before onset of major bleeding, 9 patients (90%) had developed intra-abdominal abscess resulting from pancreatic fistula or other anastomotic leak, and all 10 patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm in all 10 patients. Transcatheter arterial embolization achieved temporary control of bleeding in all 8 patients for whom embolization was attempted and complete hemostasis in 5 of the 8 subsequently, yielding a success rate of 63%. Overall, 4 patients (40%) died of complications related directly to the major hemorrhage or the transcatheter arterial embolization technique. Conclusions: An emergency angiography should be considered in all patients who develop either a sentinel or massive gastrointestinal bleed following pancreatectomy irrespective of suspected intra-abdominal sepsis. Transcatheter arterial embolization allows temporary control of massive hemorrhage and hemodynamic stabilization in most cases, and prevents the need for high-risk emergency surgery.
| Original language | English |
|---|---|
| Pages (from-to) | 1099-1102 |
| Number of pages | 4 |
| Journal | Archives of Surgery |
| Volume | 133 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 1 1998 |
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All Science Journal Classification (ASJC) codes
- Surgery
Cite this
Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy. The importance of early angiography. / Sato, Norihiro; Yamaguchi, Koji; Shimizu, Shuji; Morisaki, Takashi; Yokohata, Kazunori; Chijiiwa, Kazuo; Tanaka, Masao.
In: Archives of Surgery, Vol. 133, No. 10, 01.10.1998, p. 1099-1102.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy. The importance of early angiography
AU - Sato, Norihiro
AU - Yamaguchi, Koji
AU - Shimizu, Shuji
AU - Morisaki, Takashi
AU - Yokohata, Kazunori
AU - Chijiiwa, Kazuo
AU - Tanaka, Masao
PY - 1998/10/1
Y1 - 1998/10/1
N2 - Objective: To evaluate the efficacy of early angiography in the diagnosis and treatment of delayed arterial hemorrhage as a significant complication following pancreatectomy. Design: Retrospective case series. Setting: University hospital; 6-year period between January 1992 and December 1997. Patients and Intervention: Of a total of 81 patients undergoing pancreatic head resection, 10 (12%) developed massive arterial hemorrhage after surgery. All 10 patients underwent an emergency angiography and 8 of these were managed by transcatheter arterial embolization. Results: Before onset of major bleeding, 9 patients (90%) had developed intra-abdominal abscess resulting from pancreatic fistula or other anastomotic leak, and all 10 patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm in all 10 patients. Transcatheter arterial embolization achieved temporary control of bleeding in all 8 patients for whom embolization was attempted and complete hemostasis in 5 of the 8 subsequently, yielding a success rate of 63%. Overall, 4 patients (40%) died of complications related directly to the major hemorrhage or the transcatheter arterial embolization technique. Conclusions: An emergency angiography should be considered in all patients who develop either a sentinel or massive gastrointestinal bleed following pancreatectomy irrespective of suspected intra-abdominal sepsis. Transcatheter arterial embolization allows temporary control of massive hemorrhage and hemodynamic stabilization in most cases, and prevents the need for high-risk emergency surgery.
AB - Objective: To evaluate the efficacy of early angiography in the diagnosis and treatment of delayed arterial hemorrhage as a significant complication following pancreatectomy. Design: Retrospective case series. Setting: University hospital; 6-year period between January 1992 and December 1997. Patients and Intervention: Of a total of 81 patients undergoing pancreatic head resection, 10 (12%) developed massive arterial hemorrhage after surgery. All 10 patients underwent an emergency angiography and 8 of these were managed by transcatheter arterial embolization. Results: Before onset of major bleeding, 9 patients (90%) had developed intra-abdominal abscess resulting from pancreatic fistula or other anastomotic leak, and all 10 patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm in all 10 patients. Transcatheter arterial embolization achieved temporary control of bleeding in all 8 patients for whom embolization was attempted and complete hemostasis in 5 of the 8 subsequently, yielding a success rate of 63%. Overall, 4 patients (40%) died of complications related directly to the major hemorrhage or the transcatheter arterial embolization technique. Conclusions: An emergency angiography should be considered in all patients who develop either a sentinel or massive gastrointestinal bleed following pancreatectomy irrespective of suspected intra-abdominal sepsis. Transcatheter arterial embolization allows temporary control of massive hemorrhage and hemodynamic stabilization in most cases, and prevents the need for high-risk emergency surgery.
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UR - http://www.scopus.com/inward/citedby.url?scp=0031782840&partnerID=8YFLogxK
U2 - 10.1001/archsurg.133.10.1099
DO - 10.1001/archsurg.133.10.1099
M3 - Article
C2 - 9790208
AN - SCOPUS:0031782840
VL - 133
SP - 1099
EP - 1102
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 10
ER -