The most common cause of death in the postoperative period following pancreaticoduodenectomy is which of the following?

b. Intraperitoneal hemorrhage

Pancreaticoduodenectomy is a formidable operation, and until recently, average operative mortality was reported to approximate 20%. In the past few years, several centers have reported large series with operative mortalities lower than 5%. The most dreaded complication of pancreaticoduodenectomy is disruption of the pancreaticojejunostomy, which occurs in about 10% of patients. Anastomotic breakdown may lead to the development of an upper abdominal abscess or may present as a external pancreatic fistula. In its most virulent form, disruption leads to necrotizing retroperitoneal infection which may erode major arteries and veins of the upper abdomen, including the portal vein or its branches or the stump of the gastroduodenal artery. Impending catastrophe is often preceded by a small herald bleed from the drain site. Such an event is an indication to return to the operating room to widely drain the pancreaticojejunostomy and to repair the involved blood vessel. Open packing of the wound may be necessary in controlling diffuse necrosis and infection. On rare occasions, completion pancreatectomy is required to control sepsis. Intraperitoneal hemorrhage is the most common cause of death from pancreaticoduodenectomy.