Pancreaticoduodenectomy for bleeding periampullary tumors.

Periampullary neoplasms with necrosis or ulceration may have potentially troublesome and occasionally life-threatening bleeding. Four patients required pancreaticoduodenectomy for control of bleeding; three had adenocarcinoma of the duodenum and head of the pancreas, and one had an ulcerated carcinoid tumor of the duodenum. In two of these patients, incomplete resection was performed, and in one there was evidence of metastatic disease to the liver. Surgical results were excellent, postoperative courses were benign, and satisfactory palliation was provided. Improving morbidity and mortality with radical resection and aggressive radiotherapy and chemotherapy after surgery with the potential for bleeding from tumor necrosis make resection a reasonable alternative for palliation when localized but advanced disease exists.