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Peer-reviewedCC BY-NC-NDBMC surgery

Management of severe postpancreatectomy hemorrhage requiring emergency intervention: treatment pathways and surgical salvage in a single-center case series.

  • Hajime Imamura1
  • Tomohiko Adachi2
  • Ayaka Kinoshita2
  • Hideki Ishimaru3
  • Yuki Nunoshita2
  • Kouki Kurotaki2
  • Shun Nakamura2
  • Shinichiro Ogawa2
  • Baglan Askeyev2
  • Ayaka Satoh2
  • Kazushige Migita2
  • Kunihito Matsuguma2
5 more authors
  • Takashi Hamada2
  • Takanobu Hara2
  • Hajime Matsushima2
  • Masato Fujiyoshi2
  • Susumu Eguchi2
  1. 1Department of Surgery, Division of Digestive Surgery and Transplantology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. [email protected].
  2. 2Department of Surgery, Division of Digestive Surgery and Transplantology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
  3. 3Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan.
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Abstract

Background

Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatic resection. Although interventional radiology has become the preferred first-line treatment for delayed arterial hemorrhage, some patients still require surgical salvage. We aimed to describe the clinical characteristics, treatment pathways, and outcomes of severe PPH requiring emergency intervention.Methods

We retrospectively reviewed consecutive patients who underwent pancreatectomy at our institution between April 2009 and October 2025. Severe PPH was defined according to the criteria of the International Study Group of Pancreatic Surgery. Clinical characteristics, timing of onset, associated postoperative complications, treatment pathways, and outcomes were evaluated.Results

Among 750 pancreatectomies, 16 patients developed severe PPH requiring emergency intervention, yielding an overall incidence of 2.1%. The incidence was 2.7% after pancreaticoduodenectomy and 0.9% after distal pancreatectomy. Four patients had early severe grade B hemorrhage and 12 had late severe grade C hemorrhage. Initial treatment consisted of surgery first in 3 patients, interventional radiology only in 10 patients, and interventional radiology followed by surgery in 3 patients. Pseudoaneurysm was identified in 7 patients. Early severe PPH was categorized as technical failure, whereas late severe PPH was associated with postoperative pancreatic fistula, bile leakage, pseudoaneurysm, and other local postoperative complications.Conclusions

Severe PPH is a heterogeneous clinical entity requiring individualized management. Interventional radiology is the principal first-line treatment for delayed arterial hemorrhage, but endovascular hemostasis alone may not always achieve definitive clinical rescue, and selected patients still require prompt surgical salvage.

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Cite

BibTeXRIS
BibTeX
@article{imamura2026management,
  title = {{Management of severe postpancreatectomy hemorrhage requiring emergency intervention: treatment pathways and surgical salvage in a single-center case series.}},
  author = {Hajime Imamura and Tomohiko Adachi and Ayaka Kinoshita and Hideki Ishimaru and Yuki Nunoshita and Kouki Kurotaki and Shun Nakamura and Shinichiro Ogawa and Baglan Askeyev and Ayaka Satoh and Kazushige Migita and Kunihito Matsuguma and Takashi Hamada and Takanobu Hara and Hajime Matsushima and Masato Fujiyoshi and Susumu Eguchi},
  journal = {BMC surgery},
  year = {2026},
  month = jul,
  doi = {10.1186/s12893-026-04085-7},
  url = {https://europepmc.org/article/MED/42907812},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Management of severe postpancreatectomy hemorrhage requiring emergency intervention: treatment pathways and surgical salvage in a single-center case series.
AU  - Hajime Imamura
AU  - Tomohiko Adachi
AU  - Ayaka Kinoshita
AU  - Hideki Ishimaru
AU  - Yuki Nunoshita
AU  - Kouki Kurotaki
AU  - Shun Nakamura
AU  - Shinichiro Ogawa
AU  - Baglan Askeyev
AU  - Ayaka Satoh
AU  - Kazushige Migita
AU  - Kunihito Matsuguma
AU  - Takashi Hamada
AU  - Takanobu Hara
AU  - Hajime Matsushima
AU  - Masato Fujiyoshi
AU  - Susumu Eguchi
PY  - 2026
DA  - 2026/07/01
JO  - BMC surgery
DO  - 10.1186/s12893-026-04085-7
UR  - https://europepmc.org/article/MED/42907812
AB  - Background  Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatic resection. Although interventional radiology has become the preferred first-line treatment for delayed arterial hemorrhage, some patients still require surgical salvage. We aimed to describe the clinical characteristics, treatment pathways, and outcomes of severe PPH requiring emergency intervention.Methods  We retrospectively reviewed consecutive patients who underwent pancreatectomy at our institution between April 2009 and October 2025. Severe PPH was defined according to the criteria of the International Study Group of Pancreatic Surgery. Clinical characteristics, timing of onset, associated postoperative complications, treatment pathways, and outcomes were evaluated.Results  Among 750 pancreatectomies, 16 patients developed severe PPH requiring emergency intervention, yielding an overall incidence of 2.1%. The incidence was 2.7% after pancreaticoduodenectomy and 0.9% after distal pancreatectomy. Four patients had early severe grade B hemorrhage and 12 had late severe grade C hemorrhage. Initial treatment consisted of surgery first in 3 patients, interventional radiology only in 10 patients, and interventional radiology followed by surgery in 3 patients. Pseudoaneurysm was identified in 7 patients. Early severe PPH was categorized as technical failure, whereas late severe PPH was associated with postoperative pancreatic fistula, bile leakage, pseudoaneurysm, and other local postoperative complications.Conclusions  Severe PPH is a heterogeneous clinical entity requiring individualized management. Interventional radiology is the principal first-line treatment for delayed arterial hemorrhage, but endovascular hemostasis alone may not always achieve definitive clinical rescue, and selected patients still require prompt surgical salvage.
SN  - 1471-2482
ER  -