Postoperative pancreatic fistula grade C is the most severe presentation, defined by the onset of single or multiple organ failure occurring as a direct result of the fistula. This clinical situation requires a structured, stepwise approach guided by the patient's hemodynamic status.
Grade C POPF is characterised by organ failure that arises directly from the postoperative pancreatic fistula. Patients at this severity level may require surgical reoperation to manage their clinical status, alongside other targeted interventions.
For hemodynamically stable patients, an interventional radiological approach is the recommended initial step when delayed bleeding is present. The specific technique employed depends on the anatomical location of the bleeding site.
Patients with a grade C have developed single or multiple organ failure as a direct result of the POPF and might require surgical reoperation to manage the clinical status.
If the patient is hemodynamically stable, angiography with embolization should be the initial approach for delayed bleeding.
Different techniques may be used to stop bleeding, including proximal embolization and vessel occlusion at the site of the bleeding with nonabsorbable materials include polyvinylic alcohol (PVA) particles and metallic coils.
If the bleeding site is located in a major artery, for example, the superior mesenteric or the hepatic artery, stent grafting is usually the treatment of choice.
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