Pancreatic leak is a relatively common complication in patients who have undergone a pancreaticoduodenectomy. Some patients with pancreatic leak will develop massive bleeding. Tien et al identified risk factors that can help identify those patients who may have significant bleeding. The authors are from National Taiwan University in Taipei and the National Health Research Institute in Miaoli, Taiwan.


Patient selection: Patient post-pancreaticoduodenectomy with a pancreatic leak.


Risk factors associated with massive bleeding:

(1) signs of infection (fever, tachypnea, tachycardia)

(2) presence of bile in the drainage fluid



• minimum number of risk factors: 0

• maximum number of risk factors: 2

Number of Risk Factors

Risk of Bleeding






moderate to high


The odds ratio for massive bleeding are 6.2 for bile and 7.3 for signs of fever. The odds ratio if both are present is 8.6 which is less than the sum of the individual risk factors.



• These are sensitive but not specific (massive bleeding developed in 6 of 13 patients with both risk factors).


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