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KMID : 0371320020620020157
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Journal of the Korean Surgical Society
2002 Volume.62 No. 2 p.157 ~ p.161
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Hemorrhage Following Pancreatoduodenectomy
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Her Kyu-Hee
Kim Sun-Whe
Yoon Yoo-Seok
Park Yun-Chan
Park Sang-Jae
Suh Kyung-Suk
Han Jun-Gu
Lee Kuhn-Uk
Park Yong-Hyun
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Abstract
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Purpose: Hemorrhage following pancreatoduodenectomy is a severe,
life-threatening complication. This study was conducted to suggest methods
of the prevention and management of hemorrhagic complications.
Methods: We reviewed medical records of 456 patients who had
undergone pancreatoduodenectomy at Seoul National University Hospital
between January 1991 and December 2000. Results: Postoperative
bleeding occurred in 21 patients. Early hemorrhage within the postoperative
5th day amounted 5 cases, which were caused by improper intra-operative
hemostasis. Three of these patients were saved by prompt surgery and, in one
patient, conservative management. Late hemorrhage after the postoperative
5th day included 16 cases, of which 12 patients (75%) were associated with
pancreas anastomotic leaks and 8 patients displayed pseudoaneurysm.
’Sentinel bleeding’ was evident in 8 cases. Angiographic embolization was
performed in 8 cases, achieving hemostasis in 7 cases. Reoperations were
attempted in 7 cases with complete hemostasis in 2 cases. As a result, 15 of
21 patients obtained complete hemostasis and mortality rate from
postoperative hemorrhage was 28.6% (6/21). Conclusion: Successful
hemostasis was achieved by surgery in case of early hemorrhage and by
angiographic embolization in late hemorrhage. In order to prevent hemorrhage
following pancreatoduodenectomy, meticulous hemostasis and considerate
operative techniques for avoiding pancreatic anastomotic leaks or vascular
injury are essential.
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KEYWORD
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