Diagnosis and treatment for severe hemorrhage of portal vein system after pancreaticoduodenectomy

Objective To investigate the diagnosis and treatment for severe hemorrhage of portal vein system after pancreaticoduodenectomy (PD). Methods Clinical data of 6 patients with severe portal vein hemorrhage after PD in Chinese PLA General Hospital from January 2000 to December 2017 were retrospectively analyzed. All patients were male, aged 50-70 years with a median age of 56 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The primary diseases were 2 cases of distal bile duct carcinoma, 2 cases of pancreatic head ductal adenocarcinoma, 1 case of duodenal carcinoma and 1 case of duodenal papilla carcinoma. 3 patients underwent pylorus-preserving PD and 3 underwent classic PD. Results Among the 2 149 cases undergoing PD, 6 suffered from portal vein system hemorrhage after operation with an incidence of 0.28%. Portal vein hemorrhage occurred from 6 to 38 d after PD with a median of 20 d. All 6 cases were complicated with pancreatic fistula, with symptom of abdominal bleeding or hematochezia. Portal vein or superior mesenteric vein hemorrhage was confirmed by reoperation or angiography. 3 patients received portal vein stent implantation and3 underwent reoperation. After operation, 4 cases survived and 2 died of hemorrhagic shock. Conclusions Massive portal vein system hemorrhage after PD is rare. Its diagnosis depends on clinical manifestations, surgical exploration and angiography. The treatments include surgical suture and interventional therapy. Portal vein stent implantation has been proven a safe and effective treatment and can be the preferred alternative treatment for the complication. Key words: Pancreaticoduodenectomy; Portal vein; Hemorrhage; Pancreatic fistula; Radiology, interventional