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Master Thesis

Hémorragies artérielles post-opératoires retardées compliquant la chirurgie sus–mésocolique : prise en charge et conséquences

Abstract : BACKGROUND: The place of surgery and interventional radiology in the management of delayed (>24h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy. METHODS: Between 2005-2019, 57 patients (median age 64 years,) experienced 86 DHR episodes after pancreatic resection (n=26), liver transplantation (n=24) and other (n=7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting or embolization of the most likely bleeding source or surveillance. RESULTS: Mortality was 32% (n = 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Hemodynamic instability on presentation was the only predictor of death(p=0.008). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (p=0.14). Recurrence was similar after stenting and embolization (n=4/18, 22% vs n=8/26, 31%, p=0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (n=2/10, 20% vs. n=11/16, 69%, p=0.042). CONCLUSION: IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.
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Submitted on : Wednesday, October 28, 2020 - 11:30:47 AM
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Emmanuel Devant. Hémorragies artérielles post-opératoires retardées compliquant la chirurgie sus–mésocolique : prise en charge et conséquences. Médecine humaine et pathologie. 2020. ⟨dumas-02981759⟩

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