Spontaneous Hepatic Hemorrhage Following Whipple’s Procedure: A Report of Two Cases.

Abstract

Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgical operation performed for various pancreatic and periampullary pathologies. While the procedure has undergone significant refinements, it remains associated with significant morbidity and mortality.Spontaneous hepatic hemorrhage/ rupture is a rare but potentially life-threatening complication that has been reported in the literature.

We present two rare cases of spontaneous hepatic rupture following Whipple procedure. A 79-year-old male underwent Whipple procedure for periampullary carcinoma. On postoperative day 19, he suddenly developed epigastric pain, nausea and vomiting. Imaging revealed a spontaneous hepatic rupture. Similarly a 67 years old female for suspected periampullary underwent Whipple’s procedure. On postoperative day 14, she presented to emergency department with complaint of right hypochondrial pain, continuous in nature and severe in intensity and was also diagnosed with spontaneous hepatic rupture. Surprisingly, the early postoperative CT of both patients did not reveal any evidence of hepatic injury or hematoma and there was no history of trauma. Both the patients were managed conservatively and were vitally stable on discharge and follow up.

Keywords: Preiampullary Carcinoma, Spontaneous Hepatic Rupture, Subcapsular Hematoma, Whipple’s Procedure.