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Postoperative Bleeding

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Pancreatic Cancer

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Abstract

Pancreatic surgery has become a safe method of treating patients with malignant and benign pancreatic diseases. However, postpancreatectomy hemorrhage (PPH) is still a severe complication associated with mortality although the mortality rate following pancreatectomy has been decreased steadily over the past several decades. The early diagnosis and appropriate management of bleeding are essential. The International Study Group of Pancreatic Surgery (ISGPS) defined grades and classifications of PPH on the basis of three criteria: (I) time of onset, (II) location and cause, and (III) severity.

Early PPH (≤24 h) is usually the result of technical failure, and re-laparotomy should be undertaken immediately if the clinical condition is not stabilized after conservative management. Pancreatic fistula, meanwhile, is a well-known and potentially most important risk factor of late PPH (>24 h). Late PPH usually accompanies “sentinel bleed” which is the initial small intermittent bleed and signal of massive hemorrhage. If a patient with pancreatic fistula has sentinel bleeding, emergency interventional angiography is necessary. The basic therapeutic technique for PPH is transarterial embolization or stent graft insertion in the bleeding artery. Stent graft is an ideal method that can preserve organ perfusion and control bleeding simultaneously.

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Authors and Affiliations

  1. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Dong Wook Choi

  2. Department of Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea

    Huisong Lee

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  1. Dong Wook Choi
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  2. Huisong Lee
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Correspondence to Dong Wook Choi .

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Editors and Affiliations

  1. Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea (Republic of)

    Sun-Whe Kim

  2. Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Hiroki Yamaue

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Choi, D.W., Lee, H. (2017). Postoperative Bleeding. In: Kim, SW., Yamaue, H. (eds) Pancreatic Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47181-4_32

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  • DOI: https://doi.org/10.1007/978-3-662-47181-4_32

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