Fatal arterial hemorrhage after pancreaticoduodenectomy: How do we simultaneously accomplish complete hemostasis and hepatic arterial flow?

Table 1 Patients characteristics

Case number	Primary disease	Type of PD	Lymphadenectomy (categorization1)	Nerve dissection	Associated pancreatitis	Pancreatic leakage	Postoperative complications	Hemorrhage oncet2	Sentinel bleeding	Symptoms	Sepsis	Shock	Liver ischemia
1	Insulinoma	SSpPD	No	No	No	Yes	-	7	No	Active bleeding from intraperitoneal drain	Yes	Yes	No
2	Gastric cancer	PD	Yes (D2)	No	No	Yes	-	20	No	Bleeding from wound	Yes	Yes	No
3	Gallbladder cancer	HPD	Yes (regional)	Yes	No	Yes	-	58	No	Hematemesis	No	No	No
4	Neuroendoicrine tumor	Lasparoscopic PD	No	No	No	Yes	-	18	Yes	Active bleeding from intraperitoneal drain	No	Yes	No
5	Bile duct cancer	PD	Yes (regional)	No	Yes	No	Digestive anastomotic failure	11	No	Active bleeding from intraperitoneal drain	No	No	No
6	Pancreatic cancer	SSpPD	Yes (D2)	Yes	Yes	Yes	-	22	No	Active bleeding from intraperitoneal drain	No	No	No
7	Bile duct cancer	SSpPD	Yes (regional)	Yes	No	Yes	-	14	No	Active bleeding from intraperitoneal drain	Yes	No	No
8	Gastric cancer	PD	Yes (D2+)	No	No	No	Ruptured suture (staple line)	32	Yes	Active bleeding fromintraperitoneal drain	Yes	Yes	No
9	Pancreatic cancer	SSpPD	Yes (D2)	Yes	Yes	No	-	6	Yes	Active bleeding from intraperitoneal drain	Yes	Yes	No
10	Pancreatic cancer	SSpPD	Yes (D2)	Yes	Yes	Yes	-	16	No	Melena	No	No	Yes
11	Pancreatic metastasis from renal cancer	SSpPD	No	No	No	Yes	-	30	Yes	Active bleeding from intraperitoneal drain	No	Yes	No
12	Ampullary cancer	SSpPD	Yes (D1)	No	No	Yes	-	6	Yes	Active bleeding from intraperitoneal drain	No	Yes	No
13	Pancreatic cancer	PD	Yes (D2)	Yes	Yes	Yes	-	14	No	Active bleeding from intraperitoneal drain	Yes	Yes	No
14	Intraductal papillary mucinous neoplasm	PpPD	No	No	No	Yes	-	22	No	Active bleeding from intraperitoneal drain	Yes	Yes	No
15	Pancreatic cancer	SSpPD	Yes (D1)	No	Yes	No	Biliary necrosis	12	No	Active bleeding from intraperitoneal drain	Yes	Yes	No
							Ruptured cholangiojejunostomy
16	Pancreatic cancer	SSpPD	Yes (D2)	Yes	Yes	Yes	-	28	No	Abdominal pain	Yes	Yes	Yes

¹Intentional lymphadenectomy according to Japanese guidelines.

²Postoperative day after pancreaticoduodenectomy. HPD: Hepatopancreatoduodenectomy; PD: Pancreaticoduodenectomy; PpPD: Pylorus-preserving pancreaticoduodenectomy; SSpPD: Subtotal stomach-preserving pancreaticoduodenectomy.