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Il Giornale Italiano di Radiologia Medica 2018 Novembre-Dicembre;5(6):793-9

DOI: 10.23736/S2283-8376.18.00138-9


language: Italian

Acute post-pancreaticoduodenectomy hemorrhage: clinical presentation and endovascular management

Giulia M. DANESINI 1 , Carmine TIMPANI 2, Lorenzo C. PESCATORI 1, Marco TRAMARIN 3, Umberto G. ROSSI 4, Giovanni DAMIANI 3, Maurizio CARIATI 3

1 Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italia; 2 Ospedale Misericordia di Grosseto, Grosseto, Italia; 3 ASST Santi Paolo e Carlo, Ospedale San Carlo Borromeo, Milano, Italia; 4 Ente Ospedaliero Ospedali Galliera, Genova, Italia


Acute post-pancreaticoduodenectomy hemorrhage is a rare but potentially fatal condition that has to be treated in emergency setting. A multidisciplinary discussion of these kind of patients is mandatory with the cooperation of different medical fields such as interventional radiology, surgery and anesthesiology. The most alarming vascular complication of post-pancreaticoduodenectomy is gastroduodenal artery or superior mesenteric artery branch vessel pseudoaneurysm formation, with its possible rupture and consequent acute intra-abdominal hemorrhage. In these possible settings, interventional radiology may play a significant role in endovascular treatment. The aim of this article is to describe: 1) the pathophysiological mechanisms leading to pseudoaneurysm-related arterial complications; 2) the clinical presentation of acute hemorrhage after visceral pseudoaneurysm rupture; 3) the imaging techniques that are required to assess the suspected clinical diagnosis (multi-detector computed tomography and digital subtraction angiography); 4) lastly, the interventional radiology endovascular procedures needed to exclude the bleeding visceral pseudoaneurysm from systemic circulation, in order to stop the acute hemorrhage. Acute post-pancreaticoduodenectomy hemorrhage is a rare complication; when it occurs, emergency endovascular treatment is mandatory. The use of interventional radiology in such cases offers effective and minimally invasive endovascular therapeutic options that involve less complications and lower mortality compared to traditional surgical management.

KEY WORDS: Interventional radiology - False aneurysm - Hemorrhage - Pancreaticoduodenectomy

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