Liu ZJ, Hong JY, Zhang C, She J, Zhai HH. Gastrointestinal bleeding after pancreatoduodenectomy: Report of four cases. World J Gastrointest Surg 2025; 17(1): 100119 [PMID: 39872762 DOI: 10.4240/wjgs.v17.i1.100119]
Corresponding Author of This Article
Hui-Hong Zhai, MD, Director, Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. zhaihuihong@ccmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zi-Jin Liu, Jia-Yi Hong, Jing She, Hui-Hong Zhai, Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Chao Zhang, Department of Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Co-first authors: Zi-Jin Liu and Jia-Yi Hong.
Author contributions: Liu ZJ and Hong JY contributed to manuscript writing; Zhang C and She J contributed to the provision of study materials or patients; Zhai HH contributed to the conception and design, and administrative support; all authors approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patients for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Hong Zhai, MD, Director, Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. zhaihuihong@ccmu.edu.cn
Received: August 7, 2024 Revised: September 16, 2024 Accepted: October 18, 2024 Published online: January 27, 2025 Processing time: 142 Days and 2.5 Hours
Abstract
BACKGROUND
Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy. We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.
CASE SUMMARY
The main symptoms included black stool, hematochezia, haematemesis, blood in the nasogastric tube, and hemorrhagic shock. The mean age was 66.25 years old and the median onset time was 340 d after the surgery. The bleeding location comprised gastrointestinal anastomosis, bile duct-jejunum anastomosis, and extraluminal bleeding. The possible causes included marginal ulcer, jejunal varix, and abdominal infection. Endoscopic hemostatic clips, as well as a covered stent using angiography, were utilized to stop the bleeding and three patients survived. Only one patient died of gastrointestinal bleeding, abdominal bleeding, abdominal infection, hypovolemic shock, and disseminated intravascular coagulation.
CONCLUSION
Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
Core Tip: We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention. The bleeding location comprised gastrointestinal anastomosis, bile duct-jejunum anastomosis, and extraluminal bleeding. The possible etiology included marginal ulcer, jejunal varix, and abdominal infection. Endoscopic hemostatic clips, as well as a covered stent using angiography, were done to stop the bleeding and three patients survived. Only one patient died of gastrointestinal bleeding, abdominal bleeding, abdominal infection, hypovolemic shock, and disseminated intravascular coagulation. In conclusion, early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
