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April 2003

Management of Bleeding Pseudoaneurysms After Pancreatoduodenectomy

Arch Surg. 2003;138(4):458. doi:10.1001/archsurg.138.4.458-a

We read with interest the article by Otah et al1 about bleeding visceral pseudoaneurysms following pancreatoduodenectomy. We agree that angiography has diagnostic value in patients with "sentinel" bleeding after pancreatic surgery. Identifying the source of the bleeding is essential for accurate treatment. It is our policy to attempt early angiography as soon as sentinel bleeding has been recognized. With the recent advances in interventional radiology, angiographic embolization has been used to treat arterial hemorrhage following pancreatoduodenectomy.2 Because of the risk of recurrent bleeding and/or uncontrolled intra-abdominal sepsis, a surgical approach consisting of proximal and distal suture ligation of the involved artery, drainage of septic collection, and repair of anastomotic leakage or completion of total pancreatectomy must be attempted, even in critically ill patients. However, embolization does allow temporary control of massive hemorrhage and decrease the need for high-risk emergency surgery.

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