Confusing delayed hematemesis, unusual arterial hemorrhage after pancreaticoduodenectomy: a case report

J Int Med Res. 2022 Jun;50(6):3000605221109396. doi: 10.1177/03000605221109396.

Abstract

Pancreaticoduodenectomy (PD) is one of the most complex surgeries and is associated with a high rate of complications, including bleeding, delayed gastric emptying (DGE), and pancreatic fistula. Although the frequency of postoperative hemorrhage is not high, this complication results in severe adverse outcomes. A 67-year-old man was diagnosed with pancreatic cancer and underwent PD. On the tenth day after surgery, he developed hypovolemic shock with hematemesis. Urgent digital subtraction angiography identified the bleeding artery as the jejunal mesenteric artery at the afferent loop, and the bleeding artery was embolized with two coils. After digital subtraction angiography, the patient had an uneventful recovery with no further complications. Therefore, we concluded that it is possible that bleeding may occur in the afferent loop when hemorrhage occurs after PD.

Keywords: Pancreaticoduodenectomy; bowel vascular lesion; case report; digital subtraction angiography; hematemesis; jejunal mesenteric artery.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anastomosis, Surgical / adverse effects
  • Gastric Emptying
  • Hematemesis* / diagnosis
  • Hematemesis* / etiology
  • Humans
  • Male
  • Pancreatic Fistula / etiology
  • Pancreaticoduodenectomy* / adverse effects
  • Pancreaticoduodenectomy* / methods
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Postoperative Hemorrhage / etiology