Severe Bleeding After Whipple Procedures

The Whipple procedure, named after Dr. Alan Whipple in the 1930s, is a major surgery that involves the removal of the head of the pancreas, the duodenum (part of the small intestine), the gallbladder and part of the bile duct. This procedure is performed to treat various abdominal cancers, including pancreatic cancer. The invasive nature of the procedure means there are many complications that can arise including post-operative severe bleeding.

Early Bleeding

• Early bleeding, also called sentinel bleeding, may or may not indicate a serious post-operative complication. The warning bleeding could be due to small leakage in the surgical site, or due to a more serious condition of pseudoaneurysm or pancreatic fistula. In either case it is important to carefully monitor the bleeding and determine the exact location, as these steps can be life-saving.

Pseudoaneurysm

• A pseudoaneurysm is a hematoma (blood clot) surrounded by fibrous tissue and found on an artery wall. When this ruptures is can cause severe bleeding into the abdominal cavity. These usually form on a point of weakness, which in this case is the anastomotic site (the site of surgical connection between two parts).

Pancreatic Fistula

• A pancreatic fistula is leakage of the pancreatic fluids into the abdominal area or other organs caused by the damage of surgery. During surgery the remaining portion of the pancreas is surgically attached to the intestinal tract and significant leakage, including bleeding, can occur.

Treatment

• The location of the bleeding is determined through endoscopy (physical examination using an endoscope) or angiography (use of dye in the blood vessels). To treat arterial hemorrhage the patient will usually need a transfusion of red blood cells along with surgical intervention by either laparotomy, which is an incision in the abdominal wall, or transcatheter arterial embolization, which is a technique to prevent bleeding by introducing a coil occlusion device into the artery.

Mortality from Surgery

• Even with the presence of complications, some of which can be severe, the death rate from the Whipple procedure has declined in the past 20 years. Throughout the 1960s and 1970s the mortality rate was over 20 percent, quite high for a surgical procedure. However, through advancements in techniques and the realization that the experience of the surgeon and hospital plays a significant role in the outcome, most surgical centers now have a mortality rate of less than 5 percent.

Survival Rate

• To determine if the Whipple procedure and the risk of complications such as severe bleeding is an acceptable risk for you, look at the survival rates. Most patients undergo this procedure as treatment for pancreatic cancer. Pancreatic cancer treated with chemotherapy alone has a five year survival rate of less than 5 percent. However, those who choose the Whipple procedure increase their five-year survival rate to about 20 percent or up to 40 percent if the cancer has not spread to lymph nodes. For patients who undergo the procedure for benign (non-cancerous) tumors or chronic pancreatitis, the procedure is curative.