Imaging Pearls ❯ Vascular ❯ Mesenteric Arcade: Celiac and SMA
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- Sites of Bleeding s/p Whipple’s Procedure: Therapy
- Embolism with coils, glue or absorbable gelatin sponge
- Coils
- Stent grafting
- Surgery - Sites of Bleeding s/p Whipple's Procedure
- Gastroduodenal stump
- Common and proper hepatic artery erosions
- Celiac axis erosions
- Splenic artery erosions
- Inferior pancreatoduodenal artery aneurysm
- Arc of Buhler aneurysm and pseudoaneurysm (mesenteric collateral vessel that originates from common hepatic artery proximal to GDA) - Hemorrhagic Complications After Whipple Surgery: Facts
Early hemorrhage (with 24 hours) is due to GDA stump insufficiency due to technical failure
Late hemorrhage (after 24 hours) is caused by
- Ulcer
- Vascular erosion from pancreatic leak
- Fistula
- Pseudoaneurysm
- Anastomotic dehiscence "Hemorrhagic complications occur in fewer than 10% of patients after Whipple pancreatoduodenectomy but account for as many as 38% of deaths. Bleeding typically occurs from the stump of the gastroduodenal artery, but other sites of bleeding are increasingly recognized."
Hemorrhagic Complications After Whipple Surgery: Imaging and Radiologic Intervention
Puppala S et al.
AJR 2011; 196:192-197