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

Table 2 Definitive diagnosis

Case number	Bleeding site	Diagnostic modality	CT angiographic findings	Angiographic findings	Time from hemorrhage onset to definitive diagnosis (d)	Time from hemorrhage onset to EVT (d)
1	RGA	CT angiography	Extravasation	Extravasation	0	0
2	SA	CT angiography	Extravasation	Extravasation	0	141
3	RHA	CT angiography	Enlargement of pseudoaneurysm	Pseudoaneurysm; Extravasation	1	0
4	Cholangiojejunostomy	Clinical findings2	None	None	0	0
5	DPA	CT angiography	Extravasation	Extravasation	0	0
6	GDA stump	CT angiography	Extravasation	Extravasation	0	0
7	RHA	CT angiography	Extravasation	Extravasation	0	0
8	GDA stump	CT angiography	Pseudoaneurysm; Extravasation	Pseudoaneurysm	0	0
9	DPA	CT angiography	Extravasation	Extravasation; Pseudoaneurysm	0	0
10	PHA	CT angiography	Pseudoaneurysm	Obstruction of CHA; Pseudoaneurysm	0	1
11	RHA	CT angiography	Pseudoaneurysm	Pseudoaneurysm	0	0
12	GDA stump	Laparotomy3	None (hematoma only)	None (stenosis of CHA)	0	0
13	GDA stump	Angiography	Extravasation	Extravasation	0	0
14	GDA stump	CT angiography	Extravasation	Extravasation; Pseudoaneurysm	0	0
15	GDA stump	CT angiography	Minor extravasation	Extravasation; Pseudoaneurysm	0	1
16	GDA stump	CT angiography	Pseudoaneurysm; Extravasation	Pseudoaneurysm; Extravasation	0	0

¹Hematemesis and endoscopic findings.

²Two surgical approaches were challenged during 14 d.

³Bleeding from the GDA was detected during laparotomy, even though computed tomography angiography and angiographic findings did not revealed extravasation. The endovascular treatment was done under the laparotomy. CHA: Common hepatic artery; CT: Computed tomography; DPA: Dorsal pancreatic artery; EVT: Endovascular treatment; GDA: Gastroduodenal artery; RGA: Right gastric artery; RHA: Right hepatic artery; PHA: Proper hepatic artery; SA: Splenic artery.