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KMID : 0870420160200040204
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2016 Volume.20 No. 4 p.204 ~ p.207
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Pseudoaneurysm of the splenic artery - an uncommon cause of delayed hemorrhage after pancreaticoduodenectomy
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Dumitru Radu
Carbunaru Ana
Grasu Mugur
Toma Mihai
Ionescu Mihnea
Dumitrascu Traian
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Abstract
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Delayed post-pancreatectomy hemorrhage (PPH) is a relatively uncommon, but feared, complication after pancreaticoduodenectomy (PD). A splenic artery pseudoaneurysm is a rare cause of delayed PPH after a PD. This paper describes the case of a patient with PD used to treat a distal bile duct cholangiocarcinoma complicated with a clinically significant pancreatic fistula and secondary intraabdominal abscess. Computed tomography-guided drainage of the abscess was performed with an apparently favourable outcome; the patient was discharged on postoperative day (POD) 35 and the abdominal drains were removed on POD 50. On POD 80, the patient was readmitted for a severe digestive hemorrhage. Computed tomography revealed a pseudoaneurysm of the splenic artery with a subsequent hematoma formation. Immediately, an angiography was performed and coils were successfully mounted. This case illustrates the rare possibility of the development of a splenic artery pseudoaneurysm with severe delayed PPH after PD complicated with a clinically significant pancreatic fistula, even after the patient was discharged from the hospital. An interventional radiology approach represents the first treatment option in hemodynamically stable patients with high success rates.
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KEYWORD
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Pancreaticoduodenectomy, Pancreatic fistula, Delayed hemorrhage, Splenic artery pseudoaneurysm, Interventional angiography
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