Sites of Bleeding s/p Whipple’s Procedure: Therapy - Embolism with coils, glue or absorbable gelatin sponge - Coils - Stent grafting - Surgery
Sites of Bleeding s/p Whipple's Procedure - Gastroduodenal stump - Common and proper hepatic artery erosions - Celiac axis erosions - Splenic artery erosions - Inferior pancreatoduodenal artery aneurysm - Arc of Buhler aneurysm and pseudoaneurysm (mesenteric collateral vessel that originates from common hepatic artery proximal to GDA)
Hemorrhagic Complications After Whipple Surgery: Facts
Early hemorrhage (with 24 hours) is due to GDA stump insufficiency due to technical failure
Late hemorrhage (after 24 hours) is caused by - Ulcer - Vascular erosion from pancreatic leak - Fistula - Pseudoaneurysm - Anastomotic dehiscence
"Hemorrhagic complications occur in fewer than 10% of patients after Whipple pancreatoduodenectomy but account for as many as 38% of deaths. Bleeding typically occurs from the stump of the gastroduodenal artery, but other sites of bleeding are increasingly recognized."
Hemorrhagic Complications After Whipple Surgery: Imaging and Radiologic Intervention Puppala S et al. AJR 2011; 196:192-197