Objective To investigate the clinical characteristics of abdominal infection related secondary hemorrhage and partition of intra‑abdominal infection after pancreaticoduodenectomy (PD).

Methods The retrospective and descriptive study was conducted. The clinical data of 25 patients with abdominal infection related secondary hemorrhage after PD who were admitted to The First Affiliated Hospital of Xi ′an Jiaotong University from January 2009 to December 2017 were collected. There were 18 males and 7 females, aged (63±11)years. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(Q₁,Q₃). Count data were described as absolute numbers.

Results (1) Clinical charac-teristics of abdominal infection related secondary hemorrhage after PD. Of 25 patients, there were 21 cases diagnosed with pancreatic fistula, 2 cases with negative for amylase test in abdominal drainage fluid, and 2 cases with unknown conditions of pancreatic fistula. There were 16 cases with sentinel hemorrhage and 9 cases without sentinel hemorrhage. Of 25 patients, 10 cases were evaluated as grade A bleeding, 10 cases were evaluated as grade B bleeding, and 5 cases were evaluated as grade C bleeding. The types of pathogenic microorganisms cultured in the peritoneal drainage fluid of 25 patients included 7 cases of simple Gram positive (G⁺) bacteria, 6 cases of simple Gram negative (G^-) bacteria, 8 cases of both G⁺ bacteria and G^- bacteria, 1 case of G⁺ bacteria and fungi, and 3 cases of G⁺ bacteria, G^- bacteria and fungi. There were 3 cases cultured with carbapenem‑resistant Acinetobacter baumannii. There were 17 patients with fluid accumulation in the D region confirmed by abdominal computered tomography, including 2 cases of simple fluid accumulation in the D region and 15 cases of fluid accumulation in the D region and other regions. Of 25 patients, 12 cases underwent simple conservative medical treatment, 8 cases underwent digital subtraction angiography (DSA) hemostasis, 2 cases underwent DSA combined with surgical hemostasis, 1 case underwent endoscopic hemostasis, 1 case underwent surgical hemostasis, and 1 case underwent endoscopic + DSA hemostasis. Of 25 patients, 5 patients died. (2) Treatment methods and clinical outcomes of patients with abdo-minal infection in different regions of the partition of intra‑abdominal infection. Of the 17 patients with clear regions of the partition of intra‑abdominal infection, there were 6 cases with D region combined with ≤ 1 other region of the partition of intra‑abdominal infection who did not receive surgical treatment survived, there were 11 cases with D region combined with ≥2 other regions of the partition of intra‑abdominal infection who mainly received DSA or combined treatment, including 8 cases survived and 3 cases dead.

Conclusions The abdominal infection related secondary hemorrhage after pancreaticoduodenectomy is mainly due to D region of the partition of intra‑abdominal infection, and the pathogen mainly presents as mixed infection and multi-drug-resistant bacterial infection. When the spread of infected lesions leads to D region combined with ≥2 other regions of the partition of intra‑abdominal infection, the intervention measures are significantly upgraded, and the risk of patient death increases.