What are the most common causes of late hemorrhage in patients with pancreaticoduodenectomy (mark all the answers that apply)?

Question:

	1. Technical failure
	2. Abscess formation
	3. Erosions of vessels
	4. Coagulopathies
	5. Pancreatic fistulas

Answer:

The correct answers for the question "What are the most common causes of late hemorrhage in patients with pancreaticoduodenectomy (mark all the answers that apply)?" are:

2. Abscess formation

3. Erosions of vessels

5. Pancreatic fistulas

Explanation
1. Technical failure is a cause of early hemorrhage, not late hemorrhage. [Early hemorrhage is most often a result of technical failure or underlying coagulopathy, while late hemorrhage secondary to complications such as abscess formation, erosions of vessels, pancreatic fistulas, ulcerations at anastamosis sites, and the development of pseudoaneurysms].

2. Abscess formation is a cause of late hemorrhage.

3. Erosion of vessels is a cause of late hemorrhage.

4. Coagulopathies are a cause of early hemorrhage, not late hemorrhage.

5. Pancreatic fistulas are is a cause of late hemorrhage.

From the manuscript:
Post-Pancreaticoduodenectomy Hemorrhage of Unusual Origin: Treatment with Endovascular Embolization and the value of preoperative CT Angiography
Radiology Case. 2013 Apr; 7(4):29-36

This article belongs to the Interventional section.

From the manuscript

Post-Pancreaticoduodenectomy Hemorrhage of Unusual Origin: Treatment with Endovascular Embolization and the value of preoperative CT Angiography

Free full text article: Post-Pancreaticoduodenectomy Hemorrhage of Unusual Origin: Treatment with Endovascular Embolization and the value of preoperative CT Angiography

Abstract
Post-pancreaticoduodenectomy hemorrhage is a life threatening complication reported to occur in 2-7% of patients. Historically, treatment required an exploratory laparotomy. Introduction of endovascular embolization has broadened the available treatment options. The most common location for a post-pancreaticoduodenectomy hemorrhage is the gastroduodenal artery stump. Nonetheless, unusual sources of hemorrhage exist and are hard to localize, thus they are often treated with open surgery. Here we report two cases of CTA proven hemorrhage from the dorsal pancreatic arcade and transverse pancreatic artery, which were successfully located with conventional angiography and treated with endovascular arterial coil embolization. Both patients were status post-pancreaticoduodenectomy (Whipple procedure) and presented with a sentinel bleed and a drop in hematocrit levels.

References

1. Wente MN, Veit JA, Bassi C. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142:20-25