Post-op Pancreatic Hemorrhage

Postoperative pancreatic hemorrhage is a rare but severe complication, which accounts for nearly one-half of perioperative mortality and requires prompt recognition and adequate management. The International Study Group of Pancreatic Surgery (ISGPS) graded postpancreatectomy hemorrhage (PPH) in 2007 based on onset, location, and severity. Early hemorrhage is a result of insufficient hemostasis and is mostly treated by re-operation. An important warning sign for delayed hemorrhage is the “sentinel bleeding”, often associated with sepsis. The main cause of delayed hemorrhage is pseudoaneurysm. Patients should be first submitted to endovascular therapy and bleeding may be handled by applying coils or stent-grafting and complementarily by interventional drainage or surgery for the collection of infected fluid and for local sepsis control. Surgery may be challenging as a first choice therapy for late hemorrhage being a risk for new complications.