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Meram E, Russell E, Ozkan O, Kleedehn M. Variceal and Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Management: Indications and Role of Interventional Radiology. Gastrointest Endosc Clin N Am 2024; 34:275-299. [PMID: 38395484 DOI: 10.1016/j.giec.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
For over 60 years, diagnostic and interventional radiology have been heavily involved in the evaluation and treatment of patients presenting with gastrointestinal bleeding. For patients who present with upper GI bleeding and have a contraindication to endoscopy or have an unsuccessful attempt at endoscopy for identifying or controlling the bleeding, interventional radiology is often consulted for evaluation and consideration of catheter-based intervention.
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Affiliation(s)
- Ece Meram
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elliott Russell
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Orhan Ozkan
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Mark Kleedehn
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA.
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2
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Chooklin S, Chuklin S, Posivnych M, Krystopchuk S. Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding. EMERGENCY MEDICINE 2023; 19:58-69. [DOI: 10.22141/2224-0586.19.2.2023.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Hemosuccus pancreaticus is a life-threatening condition that should be considered in patients with abdominal pain, gastrointestinal hemorrhage and high serum amylase. The varied presentation of hemosuccus pancreaticus and the limited literature evidence due to its rarity make it challenging to diagnose. Diagnostic modalities include contrast-enhanced computed tomography scans, endoscopic procedures (esophagoduodenoscopy and endoscopic retrograde cholangiopancreatography) and angiography. Therapeutic management through an interventional radiology using coil embolization is safe and effective in hemodynamically stable patients with hemosuccus pancreaticus. Endosonography can be an innovative approach for the diagnosis and treatment of patients in whom contrast cannot be administered; however, its safety and efficacy need to be confirmed by future studies. This review presents current views on the diagnosis and treatment of patients with hemosuccus pancreaticus.
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3
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Busebee B, AT K, BR S, LN S, Coelho-Prabhu N. Hemosuccus Pancreaticus: Diagnostic Pitfalls of a Rare Condition. ACG Case Rep J 2023; 10:e01014. [PMID: 36998341 PMCID: PMC10043551 DOI: 10.14309/crj.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/21/2023] [Indexed: 04/01/2023] Open
Abstract
The combination of cirrhosis and chronic pancreatitis is rare and poses increased risk of hemorrhage requiring close clinical monitoring. We present a patient with history of alcohol-associated cirrhosis and chronic pancreatitis who was admitted to the intensive care unit with clinical hemorrhage believed secondary to epistaxis. After initial delay, esophagogastroduodenoscopy ultimately found blood and clots evacuating through the ampulla consistent with hemosuccus pancreaticus confirmed with computed tomography angiography. The patient ultimately improved with coil and gel foam vascular embolization. This case highlights the dangers of early diagnostic closure and presents a rare finding of hemosuccus without pseudoaneurysm formation.
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Affiliation(s)
| | - Kurdi AT
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Stultz BR
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sayegh LN
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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4
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Sahoo B, Panigrahi MK, Nayak HK, Bag ND, Mishra S, Kumar C. Haemosuccus pancreaticus: a diagnostic challenge and its management through interventional radiology. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Haemosuccus pancreaticus (HP), also known as pseudohaemobilia, is defined as upper gastrointestinal tract hemorrhage originating from the pancreatic duct into the duodenum via the ampulla of Vater or major pancreatic papilla. Pseudoaneurysm formation from the splenic artery is a common complication of pancreatitis; however, upper gastrointestinal bleed resulting from rupture of splenic artery pseudoaneurysm into the pancreatic duct is unusual and challenging to diagnose.
Case presentation
A 26-year-old patient presented with multiple episodes of hematemesis, melena, and intermittent abdominal pain. A contrast-enhanced computed tomography (CECT) scan was performed that demonstrated chronic calcific pancreatitis with a pseudoaneurysm in the splenic artery in close relation to the main pancreatic duct. The patient was immediately shifted for endovascular management, and the pseudoaneurysm was successfully embolized. Post embolization, the patient developed splenic abscess, which was managed by percutaneous catheter drainage.
Conclusion
Due to its rarity and being challenging to diagnose, the mortality rate of HP is high. A high level of expertise is required to diagnose HP, and it should be considered in all upper gastrointestinal bleed patients associated with acute or chronic pancreatitis. Rapid initial CECT and angiography should be performed to confirm the diagnosis, followed by embolization of the bleeding pseudoaneurysm to eliminate the need for surgery. This case report highlights the challenges in the diagnosis and management of HP.
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5
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Ide T, Uchikawa K, Noshiro H. Laparoscopic distal pancreatectomy for hemosuccus pancreaticus due to an intraductal papillary mucinous neoplasm. Asian J Endosc Surg 2022; 16:301-304. [PMID: 36448524 DOI: 10.1111/ases.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 12/02/2022]
Abstract
Hemosuccus pancreaticus (HP) is a condition that is defined as gastrointestinal hemorrhage which occurs through the pancreatic duct. We present the rare case of a 75-year-old woman who developed HP caused by intraductal papillary mucinous neoplasm (IPMN). She had been followed for sarcoidosis, splenic artery aneurysm and pancreatic cyst. The patient presented to the emergency room of our hospital with epigastric pain and bloody discharge. Computed tomography revealed hemorrhage from a splenic artery aneurysm in a cystic lesion of the pancreas. On angiography, extravasation from the splenic artery was observed. Thus, we performed coil embolization. After interventional radiography (IVR), magnetic resonance imaging and endoscopic retrograde pancreatography showed a branch duct IPMN. Based on these findings, elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was IPMN with HP caused by rupture of a splenic artery aneurysm. For such complicated cases, minimally invasive surgery is applicable after successful hemostasis by IVR.
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Affiliation(s)
- Takao Ide
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Kazuya Uchikawa
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
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6
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Moon SM, Paik KH, Kim JC, Park WS. A case report on the role of endoscopic retrograde cholangiopancreatography in the diagnosis of hemosuccus pancreaticus. Medicine (Baltimore) 2022; 101:e31561. [PMID: 36397353 PMCID: PMC9666211 DOI: 10.1097/md.0000000000031561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding that sometimes leads to life-threatening conditions. However, the diagnosis of HP is often delayed due to its rarity and intermittent signs of bleeding, making it challenging to determine the source of bleeding in some patients. PATIENT CONCERNS An 83-years-old man was transferred to our hospital for evaluation of the source of intermittent upper gastrointestinal bleeding involving melena and worsening anemia. DIAGNOSIS HP was diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) and sequential angiography using a multidisciplinary approach. INTERVENTIONS Initial upper and lower gastrointestinal endoscopies did not reveal any source of bleeding. Emergency upper endoscopy performed when the patient had hematochezia and hypotension confirmed a spurt of bleeding from the major duodenal papilla. However, contrast-enhanced computed tomography and angiography could not identify the source of the bleeding from the major duodenal papilla. ERCP for inducing bleeding from the source and indicating the bleeding point was performed according to the decision of the multidisciplinary team. Immediately thereafter, sequential angiography was performed and HP, due to the rupture of a pseudoaneurysm of the splenic artery, was diagnosed. As a result, surgical resection of the pancreas could be avoided by accurately embolizing the bleeding focus of HP using a multidisciplinary team approach. OUTCOMES The patient was discharged in a hemodynamically stable condition. There was no further gastrointestinal bleeding or procedure-related complication until 6 months after discharge. LESSONS HP should be considered by endoscopists during the differential diagnosis of intermittent upper gastrointestinal bleeding in patients with a history of pancreatitis. A multidisciplinary team approach is an effective method to determine the source or location of bleeding, which may reduce mortality and morbidity by avoiding additional pancreatectomies.
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Affiliation(s)
- Sung Mi Moon
- Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Jung-gu, Daejeon, Republic of Korea
| | - Kyu-Hyun Paik
- Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Jung-gu, Daejeon, Republic of Korea
| | - Ji Chang Kim
- Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Jung-gu, Daejeon, Republic of Korea
| | - Won Suk Park
- Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Jung-gu, Daejeon, Republic of Korea
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7
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Muacevic A, Adler JR. Getting Closer to an Underdiagnosed Disease: Hemosuccus Pancreaticus, a Rare Cause of Upper Gastrointestinal Bleeding. Cureus 2022; 14:e30837. [PMID: 36451650 PMCID: PMC9703953 DOI: 10.7759/cureus.30837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
Hemosuccus pancreaticus is a rare cause of upper gastrointestinal hemorrhage. It is mainly produced by bleeding from a pseudoaneurysm that runs through the pancreatic duct and flows into the second portion of the duodenum. This article presents a case of a patient in the sixth decade of life with upper gastrointestinal bleeding who underwent a computed tomography (CT) scan of the abdomen finding a pseudoaneurysm of the gastroduodenal artery. Subsequently, angiography confirmed active bleeding from the pseudoaneurysm, requiring endovascular treatment by interventional radiology, which was successful with the resolution of the bleeding. In this article, our aim is to expand the information on this pathology and to promote the optimization of diagnostic tests for the timely treatment of this rare disease that is potentially life-threatening.
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8
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Joshi A, Ca J, Gada LM, K R S, Chaitra K. Life-Threatening Upper Gastrointestinal Hemorrhage in Hemosuccus Pancreaticus: A Case Report. Cureus 2022; 14:e23934. [PMID: 35547413 PMCID: PMC9085655 DOI: 10.7759/cureus.23934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding caused by bleeding from the ampulla of Vater into the duodenum. HP most commonly results from a rupture of pseudoaneurysms secondary to chronic pancreatitis. The low incidence of HP and the wide spectrum of its clinical presentation poses diagnostic challenges. We present a case of a 39-year-old male with acute-on-chronic pancreatitis resulting in HP and obstructive jaundice due to pancreatic pseudocyst with secondary hematoma. This case highlights the rare occurrence of hypovolemic shock due to massive hemorrhage in HP and the successful management with prompt cardiovascular support and angiographic coil embolization of a bleeding pancreatic pseudoaneurysm.
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Affiliation(s)
- Amey Joshi
- General Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Jayashankar Ca
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Lakshmi Meghana Gada
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Shruthi K R
- Gastroenterology, Vagus Hospital, Bangalore, IND
| | - Kolli Chaitra
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
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9
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Matsubara K, Matsukura M, Takayama T, Hoshina K, Kanemoto H. Haemosuccus Pancreaticus Caused by Splenic Artery Aneurysm Derived From Isolated Spontaneous Coeliac Artery Dissection: Two Case Reports. EJVES Vasc Forum 2022; 55:56-58. [PMID: 35586476 PMCID: PMC9108461 DOI: 10.1016/j.ejvsvf.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Case report Conclusion Haemosuccus pancreaticus (HP) is a rare cause of gastrointenstinal bleeding. Splenic artery aneurysms derived from ISCAD may cause HP. Treatment for HP may be delayed due to difficulty in diagnosis.
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Affiliation(s)
- Kazuyoshi Matsubara
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuru Matsukura
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Takayama
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Corresponding author. Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
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10
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Tarar ZI, Khan HA, Inayat F, Goraya MHN, Raza M, Ibrahim F, Akhtar Z, Malik A, Davis RM. Hemosuccus Pancreaticus: A Comprehensive Review of Presentation Patterns, Diagnostic Approaches, Therapeutic Strategies, and Clinical Outcomes. J Investig Med High Impact Case Rep 2022; 10:23247096211070388. [PMID: 35045737 PMCID: PMC8796068 DOI: 10.1177/23247096211070388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemosuccus pancreaticus is a rare but potentially torrential and life-threatening cause of acute upper gastrointestinal bleeding. It is described as an intermittent hemorrhage from the major duodenal papilla via the main pancreatic duct. Peripancreatic pseudoaneurysm following chronic pancreatitis is a common underlying etiology. However, gastroduodenal artery pseudoaneurysm-related hemosuccus pancreaticus remains exceedingly rare in the etiological spectrum of upper gastrointestinal bleeding. We hereby delineate a rare case of hemosuccus pancreaticus associated with gastroduodenal artery pseudoaneurysm in a patient who initially presented with abdominal pain and hematochezia. He was successfully managed with coil embolization without recurrence or sequelae. Furthermore, we conducted a search of the MEDLINE (PubMed and Ovid) database for relevant studies on hemosuccus pancreaticus published between inception and September 15, 2021. The available clinical evidence on causes, presentation patterns, diagnosis, and management was analyzed and summarized. This article highlights the rarity, the intermittent nature of hemorrhage, and the lack of a standardized diagnostic approach for this elusive disease. Clinicians should remain cognizant of hemosuccus pancreaticus, especially in patients presenting with symptoms and signs of intermittent gastrointestinal bleeding and abdominal pain. Prompt diagnosis carries paramount importance in saving patients from repeat hospital admissions and disease-associated morbidity and mortality. Conventional angiography with coil embolization may constitute an effective treatment strategy.
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Affiliation(s)
| | | | - Faisal Inayat
- Allama Iqbal Medical College, Lahore, Pakistan
- Faisal Inayat, MBBS, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore 54550, Punjab, Pakistan.
| | | | - Mohsin Raza
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | | | - Adnan Malik
- Loyola University Medical Center, Maywood, IL, USA
| | - Ryan M. Davis
- University of Missouri School of Medicine, Columbia, MO, USA
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11
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Severe Gastrointestinal Bleeding Due to Hemosuccus Pancreaticus in Chronic Pancreatitis Treated With Percutaneous Trans-splenic Embolization. ACG Case Rep J 2022; 9:e00739. [PMID: 35028327 PMCID: PMC8751761 DOI: 10.14309/crj.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Hemosuccus pancreaticus is a life-threatening but rare cause of intermittent upper gastrointestinal bleeding caused by acute/subacute hemorrhage into a pancreatic duct or pancreatic pseudocyst because of a ruptured pseudoaneurysm. This entity is described in patients with pseudoaneurysms that develop in the context of severe pancreatic/peripancreatic inflammatory changes. Hemosuccus pancreaticus presents a difficult diagnostic and therapeutic conundrum because it tends to involve inflamed, friable, and tortuous vascular pathways. We present a rare case of hemosuccus pancreaticus because of splenic pseudoaneurysm presenting as duodenal hemorrhage and discuss trans-splenic embolization with a combined angiographic and ultrasound-guided approach.
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12
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Long TB, Binh NT, Dung LV, Linh LT, Luu DT, My TTT, Duc NM. Diagnosis and treatment of hemosuccus pancreaticus induced by intraductal papillary mucinous neoplasm: a case report and review of the literature. Radiol Case Rep 2021; 16:3099-3103. [PMID: 34429811 PMCID: PMC8367801 DOI: 10.1016/j.radcr.2021.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/17/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
Abstract
Determining the cause of gastrointestinal bleeding is critical to determining appropriate treatment. Upper gastrointestinal bleeding from the pancreas, referred to hemosuccus pancreaticus, is a rare entity that can cause massive and life-threatening bleeding. Diagnosis remains challenging, and the mortality rate of hemosuccus pancreaticus remains high, ranging from 9.6%–90%. In this article, we present a case that was successfully diagnosed and treated at the Department of General Surgery, Hanoi Medical University Hospital, and a review of the available literature regarding this rare disease.
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Affiliation(s)
- Tran Bao Long
- Department of Surgery, Hanoi Medical University, Ha Noi, Viet Nam
| | - Nguyen Thai Binh
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Le Viet Dung
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam
| | - Le Tuan Linh
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Doan Tien Luu
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Thieu-Thi Tra My
- Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Nguyen Minh Duc
- Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam.,Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam
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13
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Yashavanth HS, Jagtap N, Singh JR, Ramchandani M, Lakhtakia S, Tandan M, Gupta R, Vamsi M, Bhaware B, Rao GV, Reddy DN. Hemosuccus Pancreaticus: A systematic approach. J Gastroenterol Hepatol 2021; 36:2101-2106. [PMID: 33445212 DOI: 10.1111/jgh.15404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/27/2020] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Hemosuccus pancreaticus is considered as one of the rare cause of upper gastrointestinal bleeding. Intermittent nature of bleeding and lack of standardized approach for diagnosis has resulted in significant delay in definitive management. METHODS We retrospectively analyzed prospectively maintained data of patients with suspected hemosuccus pancreaticus between January 2010 and December 2019. RESULTS Out of 114 patients, 87 patients were diagnosed with hemosuccus pancreaticus. Mean age was 35.7 ± 11.7 years with 89.7% men. Median duration of bleeding before diagnosis was 10 days, with 40.2%, 10.3%, and 5.7% patients had symptoms beyond 1, 6, and 12 months, respectively. Visceral artery aneurysm was noted in 62% of cases with splenic artery aneurysm (37.9%) being the common source of bleed. Rarer causes noted were superior mesenteric artery aneurysm, pancreatic adenocarcinoma, gastrointestinal stromal tumor, and post-endoscopic retrograde cholangiopancreatography (2.3% each). Santorinirrhage was seen in 3.4% patients. Endoscopic diagnosis was possible in 64.4% of patients, and angiogram localization of bleeding source was noted in 94.2%. A 56.3% of patients underwent conventional angioembolization with 95.9% success and 28.7% underwent surgery, with overall rebleeding rate of 11.5%. CONCLUSIONS Early diagnosis of hemosuccus pancreaticus avoids prolonged suffering, multiple hospital admissions, and multiple blood transfusions. It is not uncommon in the absence of aneurysm. In cases of high suspicion, repeating the endoscopy with proper technique and proper timing increases the yield. Angioembolization remains the most preferred first line therapeutic approach in majority of cases.
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Affiliation(s)
- H S Yashavanth
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitin Jagtap
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jagadeesh Rampal Singh
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Vamsi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Bhushan Bhaware
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - G V Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D N Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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14
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Obata T, Matsumoto K, Kato H, Yamazaki T, Fujii Y, Tomoda T, Horiguchi S, Okada H. Hemosuccus Pancreaticus Due to the Rupture of a Pseudoaneurysm That Developed in an Intraductal Papillary Mucinous Neoplasm. Intern Med 2021; 60:2033-2038. [PMID: 33551406 PMCID: PMC8313918 DOI: 10.2169/internalmedicine.6445-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 76-year-old woman with branch duct intraductal papillary mucinous neoplasm (IPMN) was admitted with epigastric pain and vomiting. She had received warfarin due to a history of deep vein thrombosis. A blood test showed decreased serum hemoglobin and elevated serum amylase. Contrast-enhanced computed tomography revealed acute pancreatitis and formation of a pseudoaneurysm in the IPMN. We suspected rupture of a pseudoaneurysm and performed trans-catheter angiography. Angiography showed extravasation from the posterior superior pancreaticoduodenal artery, and coil embolization was performed. It is important to be alert for the formation of pseudoaneurysm in patients with cystic neoplasms.
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Affiliation(s)
- Taisuke Obata
- Department of Gastroenterology, Okayama University Hospital, Japan
| | | | - Hironari Kato
- Department of Gastroenterology, Okayama University Hospital, Japan
| | | | - Yuki Fujii
- Department of Gastroenterology, Okayama University Hospital, Japan
| | - Takeshi Tomoda
- Department of Gastroenterology, Okayama University Hospital, Japan
| | | | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Japan
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15
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Sonanis S, Layton B, Nicholson O, Subar DA. Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus. BMJ Case Rep 2021; 14:14/3/e239485. [PMID: 33664031 PMCID: PMC7934783 DOI: 10.1136/bcr-2020-239485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma-haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.
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Affiliation(s)
| | - Benjamin Layton
- Radiology, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Oliver Nicholson
- HPB surgery, Royal Blackburn Hospital, Blackburn, Lancashire, UK
| | - DA Subar
- HPB Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, UK
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16
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Yaghooti N, Memon J, Volpicelli N, Funderburk J, McCarthy D. Distress in the Duodenum: Diagnosis by Deduction. Dig Dis Sci 2021; 66:420-423. [PMID: 33464453 DOI: 10.1007/s10620-020-06758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/09/2022]
Affiliation(s)
- Negar Yaghooti
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA.
| | - Jawairia Memon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
| | - Nicholas Volpicelli
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
| | - Jason Funderburk
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
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17
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Cui HY, Jiang CH, Dong J, Wen Y, Chen YW. Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis: A case report and review of literature. World J Clin Cases 2021; 9:236-244. [PMID: 33511191 PMCID: PMC7809673 DOI: 10.12998/wjcc.v9.i1.236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemosuccus pancreaticus is a very rare but severe form of upper gastrointestinal hemorrhage. The most common etiology is peripancreatic pseudoaneurysm secondary to chronic pancreatitis. Due to the rarity of gastroduodenal artery pseudoaneurysms, most of the current literature consists of case reports. Limited knowledge about the disease causes diagnostic difficulty.
CASE SUMMARY A 39-year-old man with a previous history of chronic pancreatitis was hospitalized due to hematemesis and melena for 2 wk, with a new episode lasting 1 d. Two weeks prior, the patient had visited a local hospital for repeated hematemesis and melena. Esophagogastroduodenoscopy indicated hemorrhage in the descending duodenum. The patient was discharged after the bleeding stopped, but hematemesis and hematochezia recurred. Bedside esophago-gastroduodenoscopy showed no obvious bleeding lesion. On admission to our hospital, he had hematemesis, hematochezia, left middle and upper abdominal pain, severe anemia, and elevated blood amylase. After admission, intermittent hematochezia was observed. Abdominal contrast-enhanced computed tomography revealed a pseudoaneurysm in the pancreas head. Angiography confirmed the diagnosis of gastroduodenal artery pseudoaneurysm. The pseudoaneurysm was successfully embolized with a coil and cyanoacrylate. No bleeding was observed after the operation. After discharge from the hospital, a telephone follow-up showed no further bleeding signs.
CONCLUSION Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis is very rare. This diagnosis should be considered when upper gastrointestinal bleeding and abdominal pain are intermittent. Abdominal enhanced computed tomography and angiography are important for diagnosis and treatment.
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Affiliation(s)
- Hai-Yu Cui
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Cheng-Hang Jiang
- Department of Emergency Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Jie Dong
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yang Wen
- Department of Radiology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - You-Wei Chen
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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18
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Ramiro Pumar G, Mendoza Jiménez-Ridruejo J, Santander Vaquero C. Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:896. [PMID: 31663362 DOI: 10.17235/reed.2019.6242/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The term 'hemosuccus pancreaticus' was first coined in 1970 by Sandblom (1). It refers to bleeding that occurs through the pancreatic duct and is a rare cause of gastrointestinal hemorrhage.
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19
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Ullah W, Hamid M, Sarwar U, Mehmood A. Pseudo to pseudo connection: pseudoaneurysm draining into the pseudocyst causing pseudohaemobillia. BMJ Case Rep 2019; 12:12/3/e228441. [PMID: 30846456 DOI: 10.1136/bcr-2018-228441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemosuccus pancreaticus (HP) is an exceedingly rare cause of lower gastrointestinal (GI) bleed where pseudoaneurysm of the peripancreatic vessels ruptures into a pancreatic pseudocyst and blood travel through the pancreatic duct, thereby, draining into GI tract via the ampulla of Vater. 1 We present a case of 65-year-old African-American woman with a history of alcohol abuse presented with melena for 1 day. The contrast-enhanced CT of abdomen/pelvis showed peripancreatic vascular pseudoaneurysm with active haemorrhage. Angiography confirmed the diagnosis of HP and successful transcatheter embolisation was performed.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Mohsin Hamid
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Usman Sarwar
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Asif Mehmood
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
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20
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Inayat F, Ali NS, Khan M, Munir A, Ullah W. Hemosuccus Pancreaticus: A Great Masquerader in Patients with Upper Gastrointestinal Bleeding. Cureus 2018; 10:e3785. [PMID: 30854272 PMCID: PMC6395018 DOI: 10.7759/cureus.3785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hemosuccus pancreaticus is a rare but life-threatening cause of upper gastrointestinal bleeding through the main pancreatic duct. This clinical entity is a difficult diagnosis due to its rarity, intermittent nature of the hemorrhage, and peculiar clinical presentation. It is still considered a surgical problem but advances in medical therapy may enable clinically stable patients to undergo less-invasive angiographic embolization. We chronicle here a unique case of hemosuccus pancreaticus in a patient presenting with melena who could not be diagnosed on multiple standard forward-viewing esophagogastroduodenoscopies and computed tomography angiography. Eventually, side-viewing duodenoscope identified the intermittent bleeding through the ampulla of Vater. This paper illustrates that clinicians should be vigilant for this etiology, especially in patients with intermittent crescendo-decrescendo abdominal pain, acute gastrointestinal hemorrhage, and elevated serum lipase levels. A multidisciplinary team approach with the centralization of gastrointestinal bleed services and a well-established management protocol is of paramount importance to reduce the morbidity and mortality of this disorder. Additionally, this article serves to outline our current understanding of the epidemiology of and risk factors for hemosuccus pancreaticus, the pathophysiology of this disease, and currently available approaches to diagnosis and treatment.
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Affiliation(s)
- Faisal Inayat
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Maryam Khan
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Ahmed Munir
- Internal Medicine, Services Institute of Medical Sciences, Lahore, PAK
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, USA
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21
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Morita Y, Sakaguchi T, Kitajima R, Furuhashi S, Kiuchi R, Takeda M, Hiraide T, Shibasaki Y, Kikuchi H, Suzuki Y, Tsukamoto K, Matsuura T, Takeuchi H. Lethal Bleeding from a Duodenal Cancerous Ulcer Communicating with the Superior Mesenteric Artery in a Patient with Pancreatic Head Cancer. Case Rep Gastroenterol 2018; 12:479-486. [PMID: 30283281 PMCID: PMC6167734 DOI: 10.1159/000492207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022] Open
Abstract
Pancreatic cancer often invades the duodenum and causes obstruction, but rarely causes massive duodenal bleeding. A 68-year-old male was admitted to our hospital because of vomiting. Enhanced abdominal CT showed a hypovascular tumor with air bubbles in the uncinate process of the pancreas. The tumor invaded the duodenum and metastasized to the liver and peritoneum. The main trunk of the superior mesenteric artery (SMA) was circumferentially involved. After admission, he had hematemesis and melena. Emergency gastroduodenoscopy revealed pulsating vessels in the third portion of the duodenum and he eventually experienced hemorrhagic shock. Severe bleeding occurred from his mouth and anus like a catastrophic flood. It was difficult to sustain blood pressure even with massive blood transfusion with pumping. After insertion of an intra-aortic balloon occlusion catheter, the massive bleeding was eventually stopped. Although we attempted interventional radiography, aortography revealed direct communication between the main SMA trunk and the duodenal lumen. The tumor was considered anatomically and oncologically unresectable. Thus, we did not perform further intervention. The patient died 2 h after angiography. Herein, we report the case of pancreatic head cancer causing lethal bleeding associated with tumor-involved SMA. Duodenal bleeding associated with pancreatic cancer invasion should be considered as an oncogenic emergency.
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Affiliation(s)
- Yoshifumi Morita
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takanori Sakaguchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryo Kitajima
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoru Furuhashi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryota Kiuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Takeda
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takanori Hiraide
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasushi Shibasaki
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotoshi Kikuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuji Suzuki
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kei Tsukamoto
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoharu Matsuura
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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22
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Hemosuccus Pancreaticus: A Rare Bleeding Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery Treated with Embolization. Case Rep Surg 2018; 2018:2354169. [PMID: 30245902 PMCID: PMC6139223 DOI: 10.1155/2018/2354169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/15/2018] [Indexed: 11/28/2022] Open
Abstract
Hemosuccus pancreaticus is a very rare cause of gastrointestinal bleeding and can be life-threatening if not managed appropriately. Still thought to be a surgical problem, advances in medical therapy now afford these patients the opportunity to undergo less-invasive angiography techniques to manage this illness when it occurs. Here, we present a case of hemosuccus pancreaticus safely managed with liquid N-butyl-2-cyanoacrylate embolization.
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23
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Patel R, Girgis M. Splenic artery pseudoaneurysm with hemosuccus pancreaticus requiring multimodal treatment. J Vasc Surg 2018; 69:592-595. [PMID: 30154016 DOI: 10.1016/j.jvs.2018.06.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/16/2018] [Indexed: 11/25/2022]
Abstract
Termed hemosuccus pancreaticus by Sandblom in 1970, hemorrhage from the pancreatic duct into the gastrointestinal tract represents a rare and challenging problem. Patients present with repeated upper gastrointestinal bleeding that is intermittent but often self-limited. In most cases, this pathophysiologic process is secondary to pancreatitis, chronic inflammation, and subsequent splenic artery pseudoaneurysm bleeding. Previously treated with open splenectomy and distal pancreatectomy, hemosuccus pancreaticus is now often managed with minimally invasive endovascular means. We describe an uncommon presentation of hemosuccus pancreaticus in the absence of prior pancreatitis, requiring open splenectomy, distal pancreatectomy, and celiac artery ligation after failed endovascular intervention.
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Affiliation(s)
- Rhusheet Patel
- Division of Vascular and Endovascular Surgery, Department of Surgery, UCLA, Los Angeles, Calif.
| | - Mark Girgis
- Division of Surgical Oncology, Department of Surgery, UCLA, Los Angeles, Calif
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24
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Mehta T, Serrano O. Intra-abdominal ticking time bomb: haemosuccus pancreaticus. BMJ Case Rep 2018; 2018:bcr-2018-226060. [PMID: 30061141 DOI: 10.1136/bcr-2018-226060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 48-year-old man presented in a near-syncopal state with a 3-day history of melaena, anaemia and epigastric pain. His medical history was significant for chronic autoimmune sclerosing pancreatitis and three previous hospitalisations for enigmatic gastrointestinal bleeding. Symptomatic treatment for anaemia was coupled with oesophagogastroduodenoscopy, two colonoscopies and video capsule endoscopy, but all failed to identify a source of gastrointestinal bleeding. CT angiography of the abdomen revealed extravasation of contrast from a small branch of the splenic artery, later identified as a splenic artery pseudoaneurysm, which was subject to two separate failed embolisation attempts. The patient eventually required a splenectomy to abate the haemorrhaging. One-month postsplenectomy, the patient was haemodynamically stable but required readmission due to significant epigastric abdominal pain secondary to acute exacerbation of pancreatitis.
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Affiliation(s)
- Tej Mehta
- School of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Oluwagbenga Serrano
- Gastroenterology, Avera McKennan Hospital, University Health Center, Sioux Falls, South Dakota, USA
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25
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Chang MA, Savides TJ. Endoscopic Management of Nonvariceal, Nonulcer Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2018; 28:291-306. [PMID: 29933776 DOI: 10.1016/j.giec.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nonvariceal, nonulcer upper gastrointestinal hemorrhage (UGIH) is a less common cause for acute upper gastrointestinal bleeding. However, nonvariceal, nonulcer UGIH is an important entity to identify and treat appropriately to prevent bleeding-related morbidity and mortality. Over the past 40 years, there has been a revolution in gastrointestinal endoscopy and a similar revolution in the management of UGIH. The aim of this article is to focus on the endoscopic management of nonvariceal, nonulcer UGIH, with a focus on the newer diagnostic and treatment modalities currently available.
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Affiliation(s)
- Michael A Chang
- Division of Gastroenterology, University of California, 9500 Gilman Drive #0956, La Jolla, CA 92093-0956, USA.
| | - Thomas J Savides
- Division of Gastroenterology, University of California, 9500 Gilman Drive #0956, La Jolla, CA 92093-0956, USA
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26
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Yu P, Gong J. Hemosuccus pancreaticus: A mini-review. Ann Med Surg (Lond) 2018; 28:45-48. [PMID: 29744052 PMCID: PMC5938526 DOI: 10.1016/j.amsu.2018.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 12/17/2022] Open
Abstract
Determining the cause of obscure bleeding in the gastrointestinal tract is the key in treating the disease. Hemosuccus pancreaticus (HP) could be an extremely rare disease. Ordinarily, bleeding in the pancreatic duct is defined as HP. At present, HP is the least frequent cause of upper gastrointestinal bleeding (1/1500), but can lead to massive gastrointestinal bleeding, which is potentially life threatening. Owing to its rarity, HP is difficult to diagnose, and the mortality rate of HP remains high in various studies. The purpose of this study is to expound on the basic symptoms and mechanisms of HP and to describe a potential significant examination method and treatment for usage in clinical practice.
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Affiliation(s)
| | - Jianping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, NO. 74 Linjiang Road, Chongqing, 400010, People's Republic of China
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27
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Cathcart S, Birk JW, Tadros M, Schuster M. Hemobilia: An Uncommon But Notable Cause of Upper Gastrointestinal Bleeding. J Clin Gastroenterol 2017. [PMID: 28644311 DOI: 10.1097/mcg.0000000000000876] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOAL AND BACKGROUND A literature review to improve practitioners' knowledge and performance concerning the epidemiology, diagnosis, and management of hemobilia. STUDY A search of Pubmed, Google Scholar, and Medline was conducted using the keyword hemobilia and relevant articles were reviewed and analyzed. The findings pertaining to hemobilia etiology, investigation, and management techniques were considered and organized by clinicians practiced in hemobilia. RESULTS The majority of current hemobilia cases have an iatrogenic cause from either bile duct or liver manipulation. Blunt trauma is also a significant cause of hemobilia. The classic triad presentation of right upper quadrant pain, jaundice, and upper gastrointestinal bleeding is rarely seen. Computed tomography and magnetic resonance imaging are the preferred diagnostic modalities, and the preferred therapeutic management includes interventional radiology and endoscopic retrograde cholangiopancreatography. Surgery is rarely a therapeutic option. CONCLUSIONS With advances in computed tomography and magnetic resonance imaging technology, diagnosis with these less invasive investigations are the favored option. However, traditional catheter angiography is still the gold standard. The management of significant hemobilia is still centered on arterial embolization, but arterial and biliary stents have become accepted alternative therapies.
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Affiliation(s)
- Scott Cathcart
- *Albany Medical Center, Albany Medical College Departments of §Radiology ‡Gastroenterology & Hepatology, Albany Medical Center, Albany, NY †Division of Gastroenterology & Hepatology, Gastroenterology & Hepatology Fellowship Program, UConn School of Medicine, Farmington, CT
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28
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Hemosuccus pancreaticus. Indian Pediatr 2017; 54:147-148. [DOI: 10.1007/s13312-017-1019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Bairagi A, Aronson DC. Nontraumatic Hemobilia in Children. European J Pediatr Surg Rep 2015; 3:23-6. [PMID: 26171310 PMCID: PMC4487122 DOI: 10.1055/s-0034-1372462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/06/2022] Open
Abstract
Nontraumatic hemobilia is a rare cause of upper gastrointestinal hemorrhage in children. In the developing world, infections and inflammation are the two most common causes. Two patients are presented illustrating the diagnostic difficulties. Following recognition of the site of bleeding the surgery was successful in each case. After a review of the literature, a diagnostic workup is proposed.
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Affiliation(s)
- Anjana Bairagi
- Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, Durban, South Africa
| | - Daniel C Aronson
- Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, Durban, South Africa
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30
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Ferreira J, Tavares AB, Costa E, Maciel J. Hemosuccus pancreaticus: a rare complication of chronic pancreatitis. BMJ Case Rep 2015; 2015:bcr-2015-209872. [PMID: 26113590 DOI: 10.1136/bcr-2015-209872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hemosuccus pancreaticus is a very rare cause of gastrointestinal bleeding and it should be considered in every patient with history of chronic pancreatitis who presents with acute or intermittent gastrointestinal haemorrhage. A 54-year-old man with a history of chronic alcoholic pancreatitis was admitted to hospital for an acute exacerbation. During hospital stay, he presented with haematemesis and haemodynamic instability. Upper gastrointestinal endoscopy revealed a blood clot on Vater papilla. CT investigation showed a 4 cm cephalopancreatic pseudocyst and angiography identified a large pseudoaneurysm of the right gastroepiploic artery, bleeding into the pseudocyst-hemosuccus pancreaticus. Microcoil transcatheter embolisation was performed with success.
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Affiliation(s)
- Joana Ferreira
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Elsa Costa
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Jorge Maciel
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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31
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Wang W, Chen W, Li KW, Chen T, Wang J. Upper gastrointestinal hemorrhage due to a fistula between the splenic vein and main pancreatic duct: A rare case. J Dig Dis 2015; 16:241-4. [PMID: 25420959 DOI: 10.1111/1751-2980.12215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Wei Wang
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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32
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Holt BA, Hawes R, Varadarajulu S. Hemosuccus pancreaticus caused by superior mesenteric artery fistula presenting as pancreatic panniculitis and anemia. Clin Gastroenterol Hepatol 2014; 12:e97-8. [PMID: 24681082 DOI: 10.1016/j.cgh.2014.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Bronte A Holt
- Florida Hospital Center for Interventional Endoscopy, Orlando, Florida
| | - Robert Hawes
- Florida Hospital Center for Interventional Endoscopy, Orlando, Florida
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33
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Abstract
The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients. Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds. Deep enteroscopy has also an added advantage of therapeutic potential. Computed tomography is helpful in identifying extra-intestinal lesions. In cases of difficult diagnosis, surgery and intra-operative enteroscopy can help with diagnosis and management. The treatment is dependent upon the aetiology of the bleed. An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy. Small bowel bleeding can be managed by conservative, radiological, pharmacological, endoscopic and surgical methods, depending upon indications, expertise and availability. Some patients, especially those with multiple vascular lesions, can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.
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Affiliation(s)
- Deepak Gunjan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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34
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Mandaliya R, Krevsky B, Sankineni A, Walp K, Chen O. Hemosuccus Pancreaticus: A Mysterious Cause of Gastrointestinal Bleeding. Gastroenterology Res 2014; 7:32-37. [PMID: 27785267 PMCID: PMC5051140 DOI: 10.14740/gr596w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 02/07/2023] Open
Abstract
Hemosuccus pancreaticus (bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of Vater) is a rare, potentially life-threatening and obscure cause of upper gastrointestinal bleeding. It is caused by rupture of the psuedoaneurysm of a peripancreatic vessel into pancreatic duct or pancreatic psuedocyst in the context of pancreatitis or pancreatic tumors. It can pose a significant diagnostic and therapeutic dilemma due to its anatomical location and that bleeding into the duodenum is intermittent and cannot be easily diagnosed by endoscopy. A 61-year-old female with HIV and alcoholism presented with 3 weeks of intermittent abdominal pain and melena. Examination revealed hypotension with pallor and mild epigastric tenderness. She was found to have severe anemia and a high serum lipase. It was decided to perform a contrast-enhanced computed tomography (CT) scan that demonstrated a hemorrhagic pancreatic pseudocyst with possible active bleeding into the cyst. An emergent angiogram showed a large pseudoaneurysm of the pancreaticoduodenal artery that was successfully embolized. Subsequent endoscopy showed blood near ampulla of Vater confirming the diagnosis of hemosuccus pancreaticus. Thus the bleeding pseudocyst was communicating with pancreatic duct. The patient had no further episodes of gastrointestinal bleeding. Hemosuccus pancreaticus should be considered in patients with intermittent crescendo-decrescendo abdominal pain, gastrointestinal bleeding and a high serum lipase. Contrast-enhanced CT scan can be an excellent initial diagnostic modality and can lead to prompt angiography for embolization of the bleeding pseudoaneurysm and can eliminate the need for surgery.
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Affiliation(s)
- Rohan Mandaliya
- Department of Internal Medicine, Abington Memorial Hospital, Abington, PA, USA
| | - Benjamin Krevsky
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Abhinav Sankineni
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Kiley Walp
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Oliver Chen
- Department of Radiology, Temple University School of Medicine, Philadelphia, PA, USA
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