Hemostatic Spray; A Rescue to Severe Post-pancreaticoduodenectomy Hemorrhage - A Novel Technique to use

Author(s): Azka Naeem, Awais A Malik, Rohma A Rana, Ghiasul Hassan, Farooq Afzal

Pancreaticoduodenectomy (Whipple’s Procedure) being an immensely intricate procedure, is accompanied by morbidities out of which some can pose a considerable threat to human life. A morbidity worth discussing is post-pancreaticoduodenectomy hemorrhage. Being classified as early or late and mild, moderate or severe, PPH can be life threatening leading to hypovolemic shock and death if untreated. We describe a case of a 52 year old South-Asian female, who underwent pancreaticoduodenectomy with pancreatico-gastrostomy for a non metastatic periampullary tumor, experienced an intraluminal post pancreaticoduodenectomy hemorrhage on fourth postoperative day leading to hypovolemic shock, with no evidence of extraluminal bleed. Urgent upper gastrointestinal endoscopy showed ulcerated pancreaticogastric anastomosis and marginal ulcer at the site of anastomosis of small intestine and stomach. Hemostatic spray was applied and hemostasis was secured. After meticulous literature review, it became evident that hemostatic spray has been used for a variety of cases of upper gastrointestinal bleeding but has never been utilized for the post-pancreaticoduodenectomy hemorrhage as delineated in the concise discussion of the article.

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