Unusual massive venous hemorrhage after pancreatoduodenectomy treated by endovascular approach.
Fiche publication
Date publication
mai 2024
Journal
Journal of surgical case reports
Auteurs
Membres identifiés du Cancéropôle Est :
Pr AYAV Ahmet, Pr GERMAIN Adeline
Tous les auteurs :
Alfaifi J, Buisset C, Postillon A, Orry X, Chanty H, Germain A, Ayav A
Lien Pubmed
Résumé
Most post-pancreaticoduodenectomy hemorrhages (PPH) are of arterial origin, and some studies have suggested that an interventional radiology approach is most effective in reducing mortality. Venous PPH is rare, and identifying its source can be challenging. We report a case of late venous PPH in the context of a pancreatic fistula following pancreaticoduodenectomy. During surgical exploration, the area of potential bleeding was inaccessible due to major inflammatory adhesions aggravated by the presence of pancreatic fistula and the delay of relaparotomy. No intra-abdominal bleeding was detected on imaging studies or during abdominal exploration; only a massive bleeding through the drain orifice, which required packing, was observed. Percutaneous transhepatic portography was performed to localize and treat the origin of the bleeding. The hemorrhage was successfully treated by endovascular approach. We found no reports in the literature on the use of interventional radiology with venous stenting to treat venous PPH, except in cases of gastrointestinal variceal hemorrhage due to portal occlusion.
Mots clés
endovascular, hemorrhage, pancreaticoduodenectomy, stent, surgery, venous
Référence
J Surg Case Rep. 2024 05;2024(5):rjae256