Abstract
To analyze the clinical characteristics, diagnostic approaches, and therapeutic outcomes of delayed post-pancreatectomy hemorrhage (DPPH) following distal pancreatectomy (DP), in order to guide clinical decision-making. Methods A retrospective review based on the clinical data of 63 patients who developed DPPH after DP between July 2018 and December 2023 at our center was conducted. According to the International Study Group for Pancreatic Surgery (ISGPS) classification, 29 cases were grade B (ISGPS-B group) and 34 were grade C (ISGPS-C group). Relevant risk factors, clinical features, and management strategies of DPPH were evaluated. Results Of these, 22 underwent spleen-preserving DP (Kimura, n=19; Warshaw, n=3) and 41 underwent DP with splenectomy. Five patients (7.9%) died from DPPH-related causes. Sentinel bleeding was observed in 21 grade C cases (61.8%). The incidence rate of clinically relevant pancreatic fistula and intra-abdominal infections in the ISGPS-C group was higher than that in the ISGPS-B group, and the difference was statistically significant (94.1% vs. 75.9%, P=0.039; 55.9% vs. 24.1%, P=0.020). The bleeding site was clearly localized in 34 cases (54.0%), with the gastroduodenal artery (n=7), splenic artery (n=6), and portal venous system (n=6) being the most common. The localization rates of contrast-enhanced CT and digital subtraction angiography (DSA) were 31.0% (13/42) and 60.9% (14/23), respectively (P=0.019). Hemostasis success rates were 80.0% (12/15) for endovascular embolization under DSA and 69.2% (18/26) for reoperation (P=0.716). In three cases of DPPH (one splenic artery stump hemorrhage and two celiac trunk hemorrhages), selective embolization of the celiac trunk was performed under DSA, with intraoperative angiography confirming adequate hepatic arterial supply, and all patients recovered uneventfully. Conclusion The gastroduodenal artery is a common bleeding site after DP. DSA provides higher localization accuracy and therapeutic efficacy, and should be considered the preferred diagnostic and therapeutic strategy for DPPH following DP.
Key words
distal pancreatectomy /
delayed postpancreatectomy hemorrhage /
digital subtraction angiography /
relaparotomy
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