A CLINICAL STUDY OF MASSIVE ABDOMINAL BLEEDING DUE TO LEAKAGE OF PANCREATOJEJUNOSTOMY IN POSTPANCRETODUODENECTOMY

The massive abdominal bleeding due to the leakage from the pancreatojejunostomy is one of the most lethal complication after pancreatoduodenectomy (PD). Subjects were 565 patients undergoing PD at the department in a period from 1968 to 1989. Of the 565 cases 16 developed massive bleeding due to anastomotic leakage. There were 12 cases bled from intraabdominal and 4 from gastrointestinal sites. Fourteen cases developed in shock. Hemostasis was made by conservative procedure in 4, by laparotomy in 8, and by transcatheter arterial embolization (TAE) in 4 cases. Of 8 cases undergoing laparotomy, exact bleeding site could be confirmed in only 3 cases, but in all cases undergoing TAE, the bleeding site was able to be confirmed. All cases undergoing surgery and conservative hemostatic treatment were lost, however, in 3 out of 4 cases undergoing TAE, their lives could be saved. In the treatment of such massive abdominal bleeding, we should consider the emergency hemostatis first and foremost and to select TAE.