Emergent arterial embolization for delayed GDA bleeding after major abdominal surgery

Postoperative hemorrhage from the gastroduodenal artery (GDA) is a rare but life-threatening complication following upper gastrointestinal surgery. Its management is particularly challenging due to the frequent co-occurrence of hypovolemic shock, complex intra-abdominal infection, and malnutrition, which collectively contribute to high morbidity and mortality. We conducted a retrospective analysis of patients who underwent either gastrectomy or pancreaticoduodenectomy and subsequently developed delayed massive GDA bleeding between January 2021 and June 2025 in the Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Six patients was included in this study, of whom five had undergone radical D2 lymphadenectomy and developed duodenal stump leakage or anastomotic leakage and one had undergone pancreaticoduodenectomy. All cases experienced massive postoperative arterial hemorrhage. Emergent angiographic arterial embolization was successfully performed in all cases, achieving effective hemostasis with satisfactory outcomes. Specifically, one patient required four sequential interventions, one required three, one required two, and the remaining three achieved hemostasis after a single emergent procedure. Notably, acute liver function abnormalities were observed in two cases following embolization of the common hepatic artery. Massive postoperative GDA hemorrhage is a life-threatening complication after abdominal surgery. Emergent arterial embolization proves to be a rapid, minimally invasive, effective, and safe therapeutic option for this critical condition.