Management and Outcome of Late Post-Pancreatectomy Hemorrhage After Pancreaticoduodenectomy: Experience From a High-Volume UK Tertiary Center

Background: Delayed bleeding after pancreaticoduodenectomy (PD) is a serious complication with significant morbidity and mortality. The aims of the study were to evaluate the incidence, management, and outcomes of late (> 24 h) post-pancreaticoduodenectomy hemorrhage (PPH) after PD in a high-volume tertiary referral center. Methods: A retrospective analysis of a prospectively maintained database of 1,184 patients who underwent PD between 2011 and 2023 was performed. Patients who developed late PPH were identified. Diagnostic investigations included computed tomography (CT) angiography, invasive angiography, and endoscopy. Interventions included endovascular treatment (embolization and/or stent graft placement) and laparotomy. Results: Twenty-three patients (1.94%) developed late PPH, at a median onset of 15.6 days after surgery. Of late PPH cases, 62.5% were associated with pancreatic fistula. Eighteen patients (78.3%) underwent endovascular therapy, whilst five patients (21.7%) required surgery. The gastroduodenal artery (GDA) was the most common source of bleeding (43.5%). In-hospital mortality was 17.4%. Conclusions: Late PPH after PD is a rare but serious complication with a high mortality rate. Early detection with CT angiography and endovascular treatment is effective in managing most cases, reducing morbidity and mortality. Surgery remains a secondary option for refractory bleeding.