Following pancreaticoduodenectomy (Whipple's procedure), the patient develops post-pancreatectomy haemorrhage on day 7, preceded by a 'sentinel bleed' and elevated drain amylase. CT shows a pseudoaneurysm of the right hepatic artery. This complication is classified as Grade C post-pancreatectomy haemorrhage by the ISGPS definition. The best initial management is:
- A Urgent re-laparotomy for hepatic artery ligation
- B Packed red blood cells and coagulation factor replacement only
- C Transcatheter arterial embolisation (TAE) or covered stent placement ✓
- D Surgical revision of the pancreatic anastomosis with haemostasis
Explanation
Post-pancreatectomy haemorrhage (PPH) Grade C (late, severe, life-threatening) from a pseudoaneurysm — typically caused by pancreatic fistula with enzymatic erosion of peripancreatic vessels — is best managed by interventional radiology (transcatheter arterial embolisation or covered stent placement) as the first-line approach. This carries lower morbidity than reoperation in the setting of an infected/fistula field. Surgical intervention is reserved when IR fails or is unavailable. ISGPS Grade C PPH requires immediate intervention (IR or surgery) as it is haemodynamically significant.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.