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©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 28, 2009; 15(32): 4090-4091
Published online Aug 28, 2009. doi: 10.3748/wjg.15.4090
Published online Aug 28, 2009. doi: 10.3748/wjg.15.4090
Arterial embolization is the best treatment for pancreaticojejunal anastomotic bleeding after pancreatoduodenectomy
Romaric Loffroy, Boris Guiu, Division of Vascular and Interventional Radiology, University of Dijon, School of Medicine, Bocage Teaching Hospital, 2 bd du Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex, France
Author contributions: Loffroy R and Guiu B contributed equally to this work; Loffroy R and Guiu B wrote the paper.
Correspondence to: Romaric Loffroy, MD, Division of Vascular and Interventional Radiology, University of Dijon, School of Medicine, Bocage Teaching Hospital, 2 bd du Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex, France. romaric.loffroy@chu-dijon.fr
Telephone: +33-380-293686
Fax: +33-380-293243
Received: July 3, 2009
Revised: July 15, 2009
Accepted: July 22, 2009
Published online: August 28, 2009
Revised: July 15, 2009
Accepted: July 22, 2009
Published online: August 28, 2009
Abstract
Massive pancreaticojejunal anastomotic bleeding, mainly from the gastroduodenal stump, is one of the most common complications of pancreatoduodenectomy. Selective angiography should be systematically the first step of investigative procedure in such situations. Pharmacoarteriography may be used if the bleeding point is not spontaneously identified, and allows safe and effective treatment with transcatheter arterial embolization compared to blind open surgical hemostasis. Coil embolization of the common or proper hepatic artery on either side of the bleeding point with “sandwich technique” is then the preferred technique to prevent retrograde filling. Surgery should be performed only as a last resort.
Keywords: Pancreatoduodenectomy, Complication, Anastomotic bleeding, Hepatic artery, Transcatheter arterial embolization