ENDOVASCULAR EMBOLIZATION OF THE RIGHT GASTROOMENTAL ARTERY IN THE RUPTURE OF THE PSEUDOANEURYSM ASSOCIATED WITH PANCREATIC FISTULA AFTER THE LONGITUDINAL PANCREATICOJEJUNOSTOMY: A CASE REPORT

Aim/Objective. To assess the feasibility of the individual approach using endovascular embolization (EVE) in patients with postoperative pancreatic fistulas (POPF) and subsequent postoperative bleeding (POB) after longitudinal pancreaticojejunostomy (LPJ) for chronic pancreatitis (CP).

Materials and methods (Case report). After performing LPJ in 33 patients was noted a low number of postoperative complications – 4/12.1 % (95 % CI: 6,2–29,4) cases with no death. We described a case report of severe complication involving POPF type «С» and later POB type «С» from the artery pseudoaneurysm.

Results. At present, there is no unified concept regarding the tactics of surgical treatment of POB in the analyzed available literature sources, that have arisen against the background of resection or resection-drainage surgical interventions for CP. The main factors of its occurrence are: postoperative pancreatitis, POPF, biliary discharge, abscess. There is a significant statistically correlation between the additional presence of bile in the drains and the occurrence of POB. Lysis of the vessel wall or the ligated stump of the artery occurs, in the case of abscess formation, which leads to the occurrence of POB.

Conclusions. It is necessary to develop and implement the algorithm for the diagnosis and treatment POB, that occur after resection and resection-drainage operations on the pancreas. This case report shows the possibility of successful EVE of the right gastroomental artery in pseudoaneurysm (POB «C») associated with pancreatic fistula (POPF «C») after longitudinal pancreaticojejunostomy

1. Rashchinski, S. M. Efficiency of longitudinal pancreaticojejunostomy / S. M. Rashchinski, S. I. Tretyak // Zdravookhraneniye. – 2023. – № 8. – P. 45–52 (in Russian).

2. Chronic pancreatitis: recent advances and ongoing challenges / S. A. Ahmed [et al.] // Curr. Probl. in Surg. – 2006. – Vol. 43, № 3. – P. 127–238.

3. Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed / I. Koukoutsis [et al.] // Dig Surg. – 2006. – Vol. 23, № 4. – P. 224–228.

4. Isaji, S. Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence / S. Isaji // J. Hepatobiliary Pancreat. Sci. – 2010. – № 17. – P. 763–769.

5. Late postpancreatectomy hemorrhage after pancreaticoduodenectomy: is it possible to recognize risk factors? / C. Ricci [et al.] // JOP. – 2012. – Vol. 13, № 2. – P. 193–198.

6. Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis / P. Limongelli [et al.] // Arch Surg. – 2008. – Vol. 143, № 10. – P. 1001–1007.

7. Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy-a systematic review with metaanalysis / S. Schorn [et al.] // Langenbecks Arch. Surg. – 2019. – Vol. 404, № 2. – P. 141–157.

8. Postoperative pancreatic fistula: an international study group (ISGPF) definition / C. Bassi [et al.] // Surgery – 2005. – Vol. 138, № 1. – P. 8–13.

9. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition / M. N. Wente [et al.] // Surgery – 2007. – Vol. 142, № 1. – P. 20–25.

10. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections / E. F. Yekebas [et al.] // Ann Surg. – 2007. – Vol. 246, № 2. – P. 269–280.