Clinical features and management strategies of delayed postoperative hemorrhage following distal pancreatectomy:a single-center study
LIN Wei-qiao
QIAN Tao
LI Hui-liang
LIU Zi-wei
GAO Shun-liang
BAI Xue-li
MA Tao
LIANG Ting-bo
Abstract：Objective To analyze the clinical characteristics,diagnostic approaches,and therapeutic outcomes of de-layed post-pancreatectomy hemorrhage(DPPH)following distal pancreatectomy(DP),in order to guide clinical decision-making.Methods A retrospective review based on the clinical data of 63 patients who developed DPPH after DP be-tween July 2018 and December 2023 at our center was conducted.According to the International Study Group for Pancre-atic Surgery(ISGPS)classification,29 cases were grade B(ISGPS-B group)and 34 were grade C(ISGPS-C group).Rel-evant risk factors,clinical features,and management strategies of DPPH were evaluated.Results Of these,22 under-went spleen-preserving DP(Kimura,n=19;War-shaw,n=3)and 41 underwent DP with splenectomy.Five patients(7.9％)died from DPPH-related causes.Sentinel bleeding was observed in 21 grade C cases(61.8％).The incidence rate of clinically rel-evant pancreatic fistula and intra-abdominal infec-tions in the ISGPS-C group was higher than that in the ISGPS-B group,and the difference was statisti-cally significant(94.1％vs.75.9％,P=0.039;55.9％vs.24.1％,P=0.020).The bleeding site was clearly localized in 34 cases(54.0％),with the gastroduodenal artery(n=7),splenic artery(n=6),and portal venous system(n=6)being the most common.The localization rates of contrast-enhanced CT and digital subtraction angiography(DSA)were 31.0％(13/42)and 60.9％(14/23),respectively(P=0.019).Hemosta-sis success rates were 80.0％(12/15)for endovascular embolization under DSA and 69.2％(18/26)for reoperation(P=0.716).In three cases of DPPH(one splenic artery stump hemorrhage and two celiac trunk hemorrhages),selective embo-lization of the celiac trunk was performed under DSA,with intraoperative angiography confirming adequate hepatic arte-rial supply,and all patients recovered uneventfully.Conclusion The gastroduodenal artery is a common bleeding site after DP.DSA provides higher localization accuracy and therapeutic efficacy,and should be considered the preferred di-agnostic and therapeutic strategy for DPPH following DP.
Keywords：distal pancreatectomydelayed postpancreatectomy hemorrhagedigital subtraction angiographyrelapa-rotomy
Publication Date：2025-10-01
Online Publishing Date：2025-12-09(First online date of this platform, not the publication date of the document)
Pages：7( 1148-1154 )