Ellen Cheang MD, Presenter: Nothing to Disclose

Danny Cheng MD, Abstract Co-Author: Nothing to Disclose

Gary Garlup Tse MD, Abstract Co-Author: Nothing to Disclose

David Cheng MD, Abstract Co-Author: Nothing to Disclose

David Vegas MD, Abstract Co-Author: Nothing to Disclose

1. Whipple pancreatoduodenectomy has up to 50% post-operative morbidity rate. Postpancreatectomy hemorrhage is seen in 24 hours). Early hemorrhage is often caused by technical failure to achieve hemostasis. Late hemorrhage is often caused by ulcers, vascular erosions, pseudoaneurysms, fistulas or anastomotic dehiscence. 3. CT angiography may help identify the bleeding site in hemodynamically stable patients. DSA delineates vascular anatomy and also guides endovascular treatment. 4. GDA stump is the most common location of hemorrhage. Less common locations include the hepatic artery, celiac axis, splenic artery, and inferior pancreaticoduodenal artery. Bleeding from an anastomotic ulcer is rare. 5. Endovascular treatments include embolization and stent grafting. If bleeding occurs from a pseudoaneurysm, packing of the pseudoaneurysm should be avoided since the weak wall is associated with a high risk of rebleeding.

1. Review of post-Whipple anatomical considerations 2. Review of common etiologies of post-Whipple hemorrhage 3. Case review of endovascular treatment of post-Whipple hemorrhage

http://abstract.rsna.org/uploads/2014/14001970/14001970_sg6x.pdf

Cheang, E, Cheng, D, Tse, G, Cheng, D, Vegas, D, Postpancreatectomy Hemorrhage: Case Review of Radiologic Imaging and Intervention.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001970.html