Transcatheter Arterial Embolization for Late Postpancreatectomy Hemorrhage of Unusual Origin (Dorsal Pancreatic Artery): A Report of Three Cases

Postpancreatectomy hemorrhage (PPH) is a rare but serious complication that can lead to death. Although the best treatment option for PPH remains controversial, transcatheter arterial embolization (TAE) has recently been introduced as a treatment with safety and efficacy, showing low morbidity and mortality, especially in late PPH (> 24 h after surgery). The most common location for PPH is the gastroduodenal artery stump; however, hemorrhage may occur from unusual sources, such as the dorsal pancreatic artery (DPA), which is often difficult to detect on angiography. Herein, the authors report three cases of delayed PPH from the DPA, occurring after a Frey procedure in one case and after pylorus-preserving pancreaticoduodenectomy in the other two. All patients were successfully treated using TAE. Although the involved artery was not identified on the first angiography in two patients, rebleeding was successfully managed by repeated endovascular procedures. Therefore, a careful and repetitive approach, based on awareness of the various causes of PPH, could increase the success rate of TAE.