Fig. 4.

Schematic illustration of the altered anatomy after a modified pylorus-sparing pancreaticoduodenectomy and our rationale of the observed postoperative pathology. a Leaking hepaticojejunostomy with transhepatic pigtail drain. b Bleeding from the gastroduodenal artery stump. c Percutaneous intraabdominal pigtail drain. d Entering of blood into transhepatic pigtail drain via the insufficient hepaticojejunostomy, mimicking an intraluminal bleeding source. e Entering of blood into percutaneous intraabdominal pigtail drain, suggesting an extraluminal bleeding source. f Entering of blood into bowel through the insufficient hepaticojejunostomy, mimicking an intraluminal bleeding source