S30 Outcomes of Pancreaticoduodenectomy for Hemorrhage at the Pancreatic Head: A Systematic Review of Retrospective Studies

Introduction: Pancreatic head hemorrhage is a life-threatening emergency often caused by traumas, malignancy, or vascular injury. Pancreaticoduodenectomy (PD) may provide definitive control when less invasive measures fail, but its emergent use carries high morbidity and variable mortality. This review aims to evaluate outcomes of PD in patients with pancreatic head hemorrhages given limited and heterogeneous data exists mostly in case reports. Methods: A medical librarian conducted a literature search of PubMed, EMBASE, Google Scholar, and LitSense from January 2000 to February 2025. We included full-text retrospectives studies written in English independently reviewed by 2 reviewers and excluded case reports, case series, editorials, and reviews. Outcomes included: mortality rates, timing of surgery (staged vs index), complication rates, reoperation needs, length of hospital stay, bleeding recurrence, and long-term functional outcomes including discharge disposition. Results: Of the 1,567 articles screened, 10 retrospective studies met inclusion criteria, encompassing 2,944 patients. In-hospital mortality ranged from 9.1% to 60%. Improved outcomes (such as lower mortality rate and fewer complications) were observed in staged PD particularly following damage control, and in elective oncologic resections compared to trauma or ulcer related hemorrhage with higher survival rates, shorter hospital stay, and better functional recovery to baseline. Penetrating trauma had no reported fistula and infections compared to blunt trauma which were reported to be 20% and 30% respectively. Overall complications remained high: pancreatic fistula (21% to 36%), infection (18% to 30%), and delayed gastric emptying (15% to 25%). The average hospital stay was 31 days, often longer in emergent settings at 35 to 42 days. Rebleeding was rare, while reoperations were common in acute cases (30% to 42%). Functional recovery varied by acuity with discharge to home (52%), rehabilitation (41%), and other facility (9%). Conclusion: PD may offer definitive hemorrhage control in select patients especially when performed electively or in a staged approach at experienced centers. Higher complication rates and prolonged hospital stays along with study heterogeneity underscore the need for prospective research to refine patient selection and improve outcomes.