Advertisement

Pancreas Resection and Pancreatitis Hemorrhage: Taking Years Off Your Life

  • Parsia A. Vagefi
  • Madhukar S. Patel
  • Keith D. LillemoeEmail author
Chapter

Abstract

A 54-year-old male with chronic pancreatitis (chronic pain, biliary and duodenal obstruction) is undergoing a pancreaticoduodenectomy procedure. During the dissection of the portal vein off of the inflamed and scarred pancreatic head/uncinate, the vein is torn. The tear is propagated into a larger hole with further attempts at dissection. You are called to help.

Keywords

Pancreatic resection hemorrhage pancreatitis pseudoaneurysm post pancreatectomy hemorrhage 

References

  1. 1.
    Agarwal AK, Raj Kumar K, Agarwal S, et al. Significance of splenic vein thrombosis in chronic pancreatitis. Am J Surg. 2008;196(2):149–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Ansari D, Tingstedt B, Lindell G, et al. Hemorrhage after major pancreatic resection: incidence, risk factors, management, and outcome. Scand J Surg. 2016;106(1):47–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Ball CG, Correa-Gallego C, Howard TJ, et al. Damage control principles for pancreatic surgery. J Gastrointest Surg. 2010;14(10):1632–3; author reply 1634.Google Scholar
  4. 4.
    Ball CG, Dixon E, Vollmer CM, et al. The view from 10,000 procedures: technical tips and wisdom from master pancreatic surgeons to avoid hemorrhage during pancreaticoduodenectomy. BMC Surg. 2015;15(1):122.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bradley EL 3rd. The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery. Int J Pancreatol. 1987;2(2):87–92.PubMedGoogle Scholar
  6. 6.
    Butler JR, Eckert GJ, Zyromski NJ, et al. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford). 2011;13(12):839–45.CrossRefGoogle Scholar
  7. 7.
    Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260(4):633–8; discussion 638–40.Google Scholar
  8. 8.
    Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261(1):12–7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Flati G, Andren-Sandberg A, La Pinta M, et al. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas. 2003;26(1):8–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Gamanagatti S, Thingujam U, Garg P, et al. Endoscopic ultrasound guided thrombin injection of angiographically occult pancreatitis associated visceral artery pseudoaneurysms: case series. World J Gastrointest Endosc. 2015;7(13):1107–13.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Glebova NO, Hicks CW, Piazza KM, et al. Technical risk factors for portal vein reconstruction thrombosis in pancreatic resection. J Vasc Surg. 2015;62(2):424–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Lillemoe KD, Yeo CJ. Management of complications of pancreatitis. Curr Probl Surg. 1998;35(1):1–98.CrossRefPubMedGoogle Scholar
  13. 13.
    Mallick IH, Winslet MC. Vascular complications of pancreatitis. JOP. 2004;5(5):328–37.PubMedGoogle Scholar
  14. 14.
    Marn CS, Edgar KA, Francis IR. CT diagnosis of splenic vein occlusion: imaging features, etiology and clinical manifestations. Abdom Imaging. 1995;20(1):78–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Sakorafas GH, Sarr MG, Farley DR, et al. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg. 2000;179(2):129–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Wellner UF, Kulemann B, Lapshyn H, et al. Postpancreatectomy hemorrhage–incidence, treatment, and risk factors in over 1,000 pancreatic resections. J Gastrointest Surg. 2014;18(3):464–75.CrossRefPubMedGoogle Scholar
  17. 17.
    Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Woods MS, Traverso LW, Kozarek RA, et al. Successful treatment of bleeding pseudoaneurysms of chronic pancreatitis. Pancreas. 1995;10(1):22–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Zyromski NJ, Vieira C, Stecker M, et al. Improved outcomes in postoperative and pancreatitis-related visceral pseudoaneurysms. J Gastrointest Surg. 2007;11(1):50–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Parsia A. Vagefi
    • 1
  • Madhukar S. Patel
    • 2
  • Keith D. Lillemoe
    • 3
    Email author
  1. 1.Liver TransplantationMassachusetts General HospitalBostonUSA
  2. 2.General SurgeryMassachusetts General HospitalBostonUSA
  3. 3.Department of SurgeryMassachusetts General HospitalBostonUSA

Personalised recommendations