Postoperative Pancreatic Fistulas Complicated by Haemorrhage: Diagnosis and Treatment

Rösch Ch, Gangl O, Langer RM, Gschwendtner M and Függer R

Department of Surgery, Austria
Institute for Radiology, Krankenhaus der Elisabethinen Linz, Austria

^*Correspondance to: Reinhold F�gger 

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Abstract:

Objective: We sought to review our experience with postoperative pancreatic fistulas complicated with bleeding.Patients and
Methods: Between January 2001 and September 2015 307 patients underwent pancreatico-duodenoectomies or central pancreatectomies. All cares were reconstructed by pancreaticojejunostomy.Results: Overall 30 day mortality was 3.6% (11 of 307 patients). Seven patients (5 males and 2 females, 65.9 years (61-74)) had late post-pancreatectomy haemorrhage (PPH) with concomitant pancreatic fistulas. Time from surgery to diagnosis was 16.3 days (range: 11-25.) CT, angiography and gastroscopy were applied to diagnose the problem. In all patients the eroded stump of the gastroduodenal artery was the underlying cause. Three patients underwent surgery and four angiographic stenting for initial treatment. We lost 1 patient due to repeated bleeding and multiple organ failure. The remaining 6 patients were hospitalized for 65 days (25-121) and recovered. During the study period our treatment strategy changed from primary surgery to angiography with stenting. We also switched our technique of pancreaticojejunostomy from one layer to duct-to-mucosa anastomosis and observed a reduction of incidence.Conclusion: PPH is a life-threatening complication which can be treated preferably with interventional techniques, surgery remains for salvage therapy.

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Cite the Article:

Rösch Ch, Gangl O, Langer RM, Gschwendtner M, Függer R. Postoperative Pancreatic Fistulas Complicated by Haemorrhage: Diagnosis and Treatment. Clin Oncol. 2016; 1: 1105.