Liu Zi-Jin, Hong Jia-Yi, Zhang Chao, She Jing, Zhai Hui-Hong
Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Department of Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
World J Gastrointest Surg. 2025 Jan 27;17(1):100119. doi: 10.4240/wjgs.v17.i1.100119.
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.
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.
Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
胰十二指肠切除术后出血是胰十二指肠切除术后最严重且危及生命的并发症之一。我们报告4例胃肠道出血患者，以阐明其恰当的治疗及预防方法。
主要症状包括黑便、便血、呕血、胃管内引流出血液及失血性休克。平均年龄66.25岁，中位发病时间为术后340天。出血部位包括胃肠道吻合口、胆管空肠吻合口及腔外出血。可能的病因包括边缘溃疡、空肠静脉曲张及腹腔感染。采用内镜止血夹以及血管造影下置入覆膜支架止血，3例患者存活。仅1例患者死于胃肠道出血、腹腔出血、腹腔感染、低血容量性休克及弥散性血管内凝血。
早期有效的内镜干预是胰十二指肠切除术后胃肠道出血患者成功止血的关键。
