Multicenter Comparative Study of Pseudoaneurysm Rupture and Non‐Pseudoaneurysm Hemorrhages Post‐Pancreatectomy

ABSTRACT Background Severe delayed post‐pancreatectomy hemorrhage (SDPPH) is a fatal complication classified into pseudoaneurysm rupture and non‐pseudoaneurysm hemorrhage. This study analyzed their clinical characteristics and outcomes. Methods A retrospective multicenter cohort study was conducted on consecutive patients who underwent pancreatic resection between January 2014 and December 2023. All SDPPH cases included in the study were confirmed by digital subtraction angiography. Results Pseudoaneurysm rupture accounted for 47.3% (44/93) of SDPPH. Overall mortality was 29.0% (27/93), without significant difference between the pseudoaneurysm and non‐pseudoaneurysm groups ( p  > 0.05). The hemorrhage sites differed significantly between groups, with the common hepatic artery and its branches (excluding gastroduodenal artery) being most frequent in the pseudoaneurysm group (15/44, 34.1%), versus other sites (including anastomosis, splenic artery, portal vein, superior mesenteric vein, and left gastric artery) in the non‐pseudoaneurysm group (22/49, 44.9%). Intensive care unit stay was shorter in the pseudoaneurysm group (1.8 ± 3.9 days) than in the non‐pseudoaneurysm group (5.3 ± 10.6 days; p  = 0.040). The clinical hemostasis success was significantly higher in the pseudoaneurysm group (81.8%, 36/44) than in the non‐pseudoaneurysm group (32.7%, 16/49; p  < 0.001). Conclusion Pseudoaneurysm rupture was associated with a better SDPPH prognosis than non‐pseudoaneurysm hemorrhage. Heightened vigilance is warranted for rebleeding in non‐pseudoaneurysm cases.