Management of Delayed Hemorrhage Following Radical Gastrectomy for Gastric Carcinoma Patients

Background/Aims: Postoperative hemorrhage, particularly delayed hemorrhage after radical gastrectomy, is a relatively rare complication, but it is lethal if not treated immediately. Methodology: The medical records of 2386 patients who underwent radical gastrectomy between June 2007 and July 2011 were analyzed with regards to postoperative delayed hemorrhagic complications. Results: Postoperative delayed hemorrhage developed in 6 (0.25%) of the 2386 patients who underwent radical gastrectomy. The time of hemorrhage was postoperative 23.8 +/- 8.3 days (range 12-32). One of these patients showed luminal hemorrhage in gastroduodenal anastomosis and achieved complete hemostasis with endoscopic treatment. The other patients with abdominal hemorrhage included four pseudoaneurysm hemorrhages and one mesocolon surface hemorrhage. Four pseudoaneurysms occurred: gastroduodenal artery pseudoaneurysms (2 cases), proper hepatic artery pseudoaneurysm (1 case) and common hepatic artery pseudoaneurysm (1 case). Hemostasis was attempted by transcatheter arterial embolization (TAE) and laparotomy in abdominal hemorrhage patients. The mean hospital stay was 32.8 +/- 37.2days (range 5-105) and the mortality rate was 50% (3/6). Conclusions: Despite the relative infrequency, delayed hemorrhage after radical gastrectomy is associated with a high mortality. Although there is a big risk of reoperation, we believe that timely laparotomy to stop bleeding is the most effective and reliable treatment to save the life of patients.