European Journal of Molecular & Clinical Medicine

Abstract

Introduction: Surgical treatment of pancreatic cancer (pancreaticoduodenectomy - PDE),
has a high risk of postoperative complications (up to 30-70%) due to its difficulty, one of
such undesirable outcomes is bleeding (up to 10% of all post PDE complication. Since
1991, a non-fatal gastrointestinal bleeding (GIB) or bleeding through drainage that follows
PDE, is called - “sentinel bleeding”; and it is a predictor of further massive fatal bleeding.
Material and methods: We present data of 64 yo male after
gastropancreaticoduodenectomy (GPDE).
Diagnosis: Moderate differentiated (MD) ductal adenocarcinoma of pancreatic head.
Massive GIB with source of bleeding as pseudoaneurysm of right hepatic artery occurred
on 21stday after GPDE. It was impossible to implant stent-graft and we failed to primary
embolize with “front-to-back-door” technique: against the background of further and
recurrent bleedings, patient underwent coiling of pseudoaneurysm and subsequent coil
implantation into right hepatic artery and common hepatic artery. Due to new recurrence
of GIB – patient underwent successful “front-to-back-door” embolization with
combination of coils and Onyx.
Results: After «front-to-back-door» embolization patient was discharged in satisfactory
condition without recurrence of bleeding. Follow-up period is18 months: no recurrence of
bleeding.
Conclusions: Bleeding after PDE should be considered as «sentinel bleeding» and
embolization should be used. Surgical hospital, carrying on resections of pancreas as a
routine, should have a CathLab unit, equipped with wide specter of angiographic
instruments and 24/7 surgical team with experience of hemostatic interventions.