Table 3.
International Study Group for Pancreatic Surgery grading of post-pancreatectomy haemorrhage after pancreatic surgery
| Grade | Time of onset, location, severity and clinical impact of bleeding | Clinical condition | Diagnostic consequence | Therapeutic consequence | |
|---|---|---|---|---|---|
| A | Early, intra- or extraluminal, mild | Well | Observation, blood count, US and, if necessary, CT | No | |
| B | Early, intra- or extraluminal, severe | Later, intra- or extraluminal, milda | Often well/intermediate, very rarely life-threatening | Observation, blood count, US, CT, angiography, endoscopyb | Transfusion of fluid-blood, intermediate care unit (or ICU), therapeutic endoscopy,b embolization, relaparotomy for early PPH |
| C | Late, intra- or extraluminal, severe | Severely impaired, life-threatening | Angiography, CT, endoscopyb | Localization of bleeding, angiography and embolization, (endoscopyb) or relaparotomy, ICU | |
a
Late, intra- or extraluminal, mild bleeding may not be immediately life-threatening to the patient but may be a warning sign of later severe haemorrhage (‘sentinel bleed’) and is therefore grade B.
b
Endoscopy should be performed when signs of intraluminal bleeding are present (melaena, haematemesis or blood loss via nasogastric tube).
US, ultrasonography; CT, computed tomography; ICU, intensive care unit; PPH, post-pancreatectomy haemorrhage.
Adopted from Wente et al.35