Bleeding pseudoaneurysms complicating upper abdominal surgery

To review the management of ruptured pseudoaneurysms following upper abdominal surgery. Retrospective study. Minimal access surgery centre, Hong Kong. Patients who were diagnosed to have a pseudoaneurysm after undergoing major upper abdominal surgery were recruited during the period of 1998 to 2006....

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Bibliographic Details
Published in:Hong Kong medical journal = Xianggang yi xue za zhi 2007-12, Vol.13 (6), p.449-452
Main Authors: Cheung, Hester Y S, Tang, C N, Fung, K H, Li, Michael K W
Format: Article
Language:eng ; chi
Subjects:
Abdomen
Abdominal surgery
Adult
Aged
Aneurysm, False - etiology
Aneurysm, False - therapy
Aneurysm, Ruptured - therapy
Cholecystectomy - adverse effects
Embolization
Embolization, Therapeutic
Female
Gastrectomy - adverse effects
Gastrointestinal Hemorrhage - therapy
Humans
Male
Medical imaging
Middle Aged
Postoperative Complications - therapy
Pseudoaneurysm
Retrospective Studies
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Summary:To review the management of ruptured pseudoaneurysms following upper abdominal surgery. Retrospective study. Minimal access surgery centre, Hong Kong. Patients who were diagnosed to have a pseudoaneurysm after undergoing major upper abdominal surgery were recruited during the period of 1998 to 2006. Success rate of haemostasis, re-bleeding rate, re-intervention rate, and mortality. During the study period, a total of eight patients (median age, 61 years) were managed in our department for bleeding pseudoaneurysms following cholecystectomy, gastrectomy, or Whipple's operation. Five patients underwent upper endoscopy as the initial investigation. In four of these five patients, visceral artery pseudoaneurysms were identified by angiography and haemostasis was achieved without re-bleeding. The one for whom angiographic identification of the bleeding source failed, was successfully treated subsequently by open plication. In three other patients, open surgical haemostasis was resorted to and achieved in two of them. However, one of the latter had re-bleeding, which was successfully treated by embolisation. The one who failed open identification of the bleeding source, was eventually also treated successfully by embolisation. The overall success rates of embolisation and open surgery were 80% and 67%, respectively, and the re-bleeding rates were 0% and 33%, respectively. The corresponding mortality rates were 20% and 33%; both deaths were associated with multi-organ failure. There were no procedure-related complications following embolisation. Based on our experience, visceral angiography can enable the diagnosis and treatment of ruptured pseudoaneurysm in a single session. The procedure is safe, the re-bleeding rate is low, and it is as effective as alternative treatments, and should be considered a first-line intervention in patients with bleeding pseudoaneurysms complicating upper abdominal surgery.
ISSN:1024-2708
2226-8707