Arterial hemorrhage after pancreatoduodenectomy. The 'sentinel bleed'
J. T. Brodsky and A. D. Turnbull
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Experienced centers report reduced operative mortality after
pancreatoduodenectomy for cancer, but significant complications continue to
occur in as many as 25% of patients. Anastomotic disruption leads to sepsis
in the pancreatic bed where major vascular structures have been exposed by
regional lymphadenectomy, creating a setting for arterial erosion or
ligature slough and massive hemorrhage. Dehiscence of the
pancreatojejunostomy is a particular risk. We treated five patients with
arterial hemorrhage after pancreatoduodenectomy, all of whom had had
"sentinel" bleeding from the abdominal drains or gastrointestinal tract.
Results of endoscopy were misleading in two patients. Three of five
patients were saved by prompt recognition, early operation, and, in one
instance, angiographic embolization. Sentinel bleeding after
pancreatoduodenectomy indicates local sepsis and probable anastomotic
dehiscence. Recognition of its significance and prompt response may prevent
exsanguination.
