Online ISSN: 2515-8260

A Case Report of Successful Endovascular Treatment of «Sentinel Bleeding» in Patient with Adverse Anatomy

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Maksim S. Kapranov1,2, Vladimir F. Kulikovskiy1 , Aleksandr A. Karpachev1 , Aleksandr V. Soloshenko1 , Adrey L. Iarosh1 , Edrees S. Al-Kanani1


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.

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