Petrovic I, Romic I, Alduk AM, Ticinovic N, Koltay OM, Brekalo K, Bogut A. Delayed postpancreatectomy hemorrhage as the role of endovascular approach: Four case reports. World J Clin Cases 2024; 12(31): 6462-6471 [PMID: 39507121 DOI: 10.12998/wjcc.v12.i31.6462]
Corresponding Author of This Article
Ivan Romic, FEBS, Postdoc, Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 14, Zagreb 10000, Croatia. iromic@kbc-zagreb.hr
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2024; 12(31): 6462-6471 Published online Nov 6, 2024. doi: 10.12998/wjcc.v12.i31.6462
Delayed postpancreatectomy hemorrhage as the role of endovascular approach: Four case reports
Igor Petrovic, Ivan Romic, Ana M Alduk, Nino Ticinovic, Oliver M Koltay, Klara Brekalo, Ante Bogut
Igor Petrovic, Department of Hepatobiliary Surgery and Transplantation, University Hospital Center Zagreb, Zagreb 10000, Croatia
Ivan Romic, Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Ana M Alduk, Department of Radiology, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb 10000, Croatia
Nino Ticinovic, Department of Radiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Oliver M Koltay, Klara Brekalo, Department of Medical School, University of Zagreb, Zagreb 10000, Croatia
Ante Bogut, Department of Internal Medicine Clinic with Dialysis Center, University Clinical Hospital Mostar, Mostar 88000, Bosnia and Herzegovina
Author contributions: Petrovic I contributed to manuscript writing and editing; Romic I, Koltay OM and Brekalo K contributed to data collection and data analysis; Alduk AM contributed to conceptualization and supervision; Ticinovic N contributed to data collection and writing; Bogut A contributed to data collection and editing.
Informed consent statement: All patients gave informed consent for the publication of this manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ivan Romic, FEBS, Postdoc, Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 14, Zagreb 10000, Croatia. iromic@kbc-zagreb.hr
Received: December 30, 2023 Revised: June 14, 2024 Accepted: August 20, 2024 Published online: November 6, 2024 Processing time: 221 Days and 8.8 Hours
Abstract
BACKGROUND
Pancreatic resection is still associated with high morbidity rates and delayed postpancreatectomy hemorrhage (PPH) is the most feared complication as it may lead to hemorrhagic shock or serious septic complications. Today, endovascular approach represent safe and efficient method for minimally invasive management of extraluminal PPH.
CASE SUMMARY
We describe four patients whose postoperative recovery after pancreatic resection was complicated by postoperative pancreatic fistula (POPF) and visceral artery hemorrhage. In all cases endovascular approach was utilized and it resulted in satisfactory outcomes. We discuss modern diagnostic and therapeutic approach in this clinical scenario.
CONCLUSION
PPH is relatively uncommon, but it is a leading cause of surgical mortality after pancreatic surgery. Careful monitoring and meticulous follow-up are required for all patients post-operatively, especially in the case of confirmed POPF, which is the most significant risk factor for the development of a PPH. Angiography as a diagnostic and therapeutic method may be an optimal first-line treatment for the management of delayed PPHs. In our experience, endovascular treatment for hemorrhagic complications of pancreatic resections has shown satisfactory results.
Core Tip: Pancreatic resections are associated with specific complications and most feared one is hemorrhage due to erosion of large peripancreatic vessels. It is rare, but serious clinical scenario which should be considered in all cases of postoperative hemodynamic instability or pulsating pain even in late postoperative phase. Nowadays, embolization may be therapeutic option for many cases of postpancreatectomy hemorrhage and it provides quick hemostasis with minimal invasiveness. Surgery is reserved for massive uncontrollable hemorrhage or when embolization fails.
