Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Abstract

Post-pancreaticoduodenectomy hemorrhage is a life-threatening complication that occurs in 2-10% of patients. The most common location for post-pancreaticoduodenectomy hemorrhage is the gastroduodenal artery stump. Nonetheless, unusual sources of hemorrhage, which are hard to locate, exist. Here, we report a rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer. A 67-year-old man presenting with appetite loss, general fatigue and painless jaundice was admitted to our ward. The patient had an elevated level of carbohydrate antigen 19-9 (50 U/mL). Computed tomography scan revealed a 17-mm wide low-density area in the uncinate process of the pancreas. Magnetic resonance cholangiopancreatography showed the dilation of bile and pancreatic ducts. Robotic-assisted pancreaticoduodenectomy was performed on the patient by using the da Vinci Model S Surgical System. On postoperative days 5 and 6, the patient vomited blood, and bloody fluid was observed in the drainage. Emergent gastroscopic examination was performed and revealed a large amount of hematocele in the stomach. On postoperative day 6, emergency operation was undertaken, and the output jejunal loop was found to have intussuscepted in the stomach. This is the first case report of output jejunal loop intussusception in the stomach that consequently caused hemorrhage after robotic-assisted pancreaticoduodenectomy for pancreatic head cancer.

Confusing delayed hematemesis, unusual arterial hemorrhage after pancreaticoduodenectomy: a case report

“…Several causes of postoperative bleeding have been reported in previous studies, such as output jejunal loop intussusception in the stomach; 8 massive hemorrhage from a ruptured celiac-hepatic artery after PD; 9 postoperative bleeding caused by pancreatitis; 10 and postoperative hemorrhage caused by a coagulation factor deficiency. 11 However, these situations were not present in our case.…”

Hepaticojejunal Intussusception After Pancreatoduodenectomy

“…In all reported cases the definitive treatment was surgical exploration with resection of the jejunum and stomach [1,3], total pancreatectomy [4] or reduction of the intussuscepted loop [2]. However, in our case the reconstruction of the alimentary tract was different, and we used two jejunal loops [5].…”

“…Intussusception after pancreatoduodenectomy is exceedingly rare with only four cases reported in the literature [1][2][3][4]. Three cases of jejunogastric intussusception and one case of jejunojejunal intussusception.…”

“…Three cases of jejunogastric intussusception and one case of jejunojejunal intussusception. Three cases presented with intussusception in late postoperative period after nine [3], 18 [2] and 60 months [4] after primary operation and one case of acute jejunogastric intussusception on the 6th postoperative day [1]. We present a unique case of acute intussusception in the hepaticojejunostomy leading to persistent jaundice.…”