Multiple episodes of postpancreatectomy hemorrhage resolved by endoscopy and ultrasound-guided percutaneous thrombin injection into a common hepatic artery aneurysm: a case report

Postpancreatectomy hemorrhage (PPH) is one of the most common complications after pancreatoduodenectomy (PD). It mainly includes gastrointestinal hemorrhage and abdominal hemorrhage. With the development of digestive endoscopy and ultrasonic/radiological interventional technology, hemostasis can be effectively performed by minimally invasive methods in many patients with PPH. This report describes the successful treatment of multiple episodes of postoperative hemorrhage after PD. The patient developed anastomotic hemorrhage after PD and was successfully treated by endoscopic hemostasis. However, he also developed intra-abdominal hemorrhage after PD caused by a pseudoaneurysm that had formed next to the common hepatic artery. We effectively performed hemostasis by injecting lyophilized thrombin powder into the pseudoaneurysm with ultrasound guidance, which is a rarely used method. This case indicates that digestive endoscopy provides great advantages in the treatment of gastrointestinal hemorrhage after PD. For patients who develop PPH with a pseudoaneurysm, interventional ultrasonography is an option if transcatheter arterial embolization or covered stenting fails.