Stenting Post-operative Abdominal Bleeding: The Interventional Radiologist's Point of View

What we have to know? Digestive ulcer especially during a stay in intensive care (stress ulcer), rupture from direct arterial or venous trauma and delayed rupture from a previously existing pseudoaneurysm are the major causes of postoperative bleedings. Posthepatectomy hemorrhage has been classified by the International Study Group of Liver Surgery [1,2]. After hepatic transplantation, bleeding is a rare complication (9% of transplantations); most common causes are bleeding from a phrenic, an epigastric or an intercostal artery. In these 2 situations, the first-line treatment option should be endovascular but surgical treatment remains indicated for venous bleeding [3]. Post pancreatectomy hemorrhage has been classified by the International Study group of pancreatic surgery [4]. After pancreatic surgery, bleeding rate (from digestive anastomoses or damaged vascular structures) is estimated between 3.3% and 10%, all types of pancreatic surgery combined [5]. In 79% of cases, the onset is late, more than 24 hours after surgery; at mean 12 days after surgery. In 69% of cases, bleeding is due to intraluminal hemorrhage of digestive anastomoses [6]. The overall rate of postoperative hemorrhage following gastrointestinal surgery for cancer is approximately 0.9%, with a mortality of approximately 20% [7]. For patients following esophageal surgery, bleeding is the cause of postoperative mortality in 9%. The rate of hemorrhagic complications following gastrectomy is 0.9% [7], with a mortality rate of 20%. Ileocolic anastomoses are associated with hemorrhagic complications in 5 to 19% of cases, depending on the surgical technique. Only 1.4% is severe [8]. During colon surgery, perioperative bleeding is the cause of 9% of coelioscopic conversions to open surgery [9]. However the risk of bleeding is not greater with coelioscopy than with laparotomy [10]. In case of rectal surgery, the risk of bleeding is mainly perioperative (3% of presacral bleeding) [11]. Nephrectomy, especially partial nephrectomy, is associated with a higher rate (4.7%) of postoperative hemorrhage [3] (TABLE 1 and 2).