Q) Post whipples on pod4 patient presented with fever, tachycardia and pain, Ultrasound showed collection, which was drained percutaneously. On pod 10 there is frank blood of 100ml in drain, next line of management
a. Ct angiography
b. Emergency laparotomy
c. Flush the drain with noradrenaline d. Observe
Ans a
This is extraluminal bleed on 10th POD following most likely a pancreatic fistula. Clinical condition is mentioned for day 4 which is because of pancreatic leak. A pancreatic fistula can cause vascular pseudo aneurysm so answer is A CT angiography
Early extraluminal PPH requires reexploration.
Intraluminal bleeding may manifest as extraluminal if there is associated anastomotic breakdown,and this may be amenable to angiographic intervention when involving the pancreaticojejunostomy.
Patients present with septic complications and/or a sentinel bleed. Radiographic embolization has become a more successful modality, with up to 80% success,13 but is limited by the initially intermittent nature of the bleeding
Exploration - if patient is not stable Ref SKF page 1241
