Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery

Background: Delayed intraperitoneal hemorrhage (DIH) is still an important cause of postoperative mortality in pancreatic and biliary surgery. Methods: Sixty-nine patients who underwent pancreatic and biliary surgery with skeletonization for lymphadenectomy of the hepatoduodenal ligament between April 2002 and March 2005 were included in this study. Statistical analyses of the risk factors for DIH were performed using both univariate and multivariate modalities. Results: DIH occurred in 4 patients (5.8%) within a median time of 15 days after surgery. Stepwise logistic regression analysis identified intra-abdominal abscess formation as the independent predictor of DIH. All 4 patients had a sentinel bleed before the onset of DIH. Three patients were treated by transarterial embolization and 1 patient was treated by surgical intervention. Three patients had liver abscess after hemostasis of DIH, but all 4 patients recovered and were discharged from the hospital. Conclusions: A computed tomography angiography should be performed on patients with intra-abdominal abscess formation and sentinel bleed after pancreatic and biliary surgery to check if a pseudoaneurysm has formed.