1
|
Hemosuccus Pancreaticus on Endoscopy. ACG Case Rep J 2022; 9:e00814. [PMID: 36117571 PMCID: PMC9478295 DOI: 10.14309/crj.0000000000000814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/06/2022] Open
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Han B, Song ZF, Sun B. Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding. Hepatobiliary Pancreat Dis Int 2012; 11:479-88. [PMID: 23060392 DOI: 10.1016/s1499-3872(12)60211-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hemosuccus pancreaticus (HP) is defined as upper gastrointestinal (GI) hemorrhage from the papilla of Vater via the pancreatic duct and is a rare cause of digestive bleeding. DATA SOURCE A PubMed search of relevant articles published from January 1967 to September 2011 was performed to identify current information about HP in terms of its etiology, pathophysiology, clinical presentation, diagnosis and management. RESULTS A variety of etiological factors, most commonly chronic pancreatitis but also tumors and vascular diseases, can lead to this condition. Appropriate endoscopic or radiologic procedures should be chosen to establish a precise diagnosis for patients, especially those with a known history of pancreatic disorders, who present with abdominal pain, GI hemorrhage and hyperamylasemia. There are two main therapeutic options for this condition: angiographic embolotherapy and surgery. Both treatments can stop bleeding, but angiographic embolotherapy is the treatment of choice for stable patients. Recently, new and less invasive treatments have emerged to treat this condition. CONCLUSIONS Because of its rarity and broad spectrum of causes, HP is difficult to diagnose accurately. However, appropriate endoscopic and radiologic procedures are extremely helpful for establishing a correct diagnosis. Both angiographic embolotherapy and surgery are reliable treatment options for this condition, and transcatheter intervention is the treatment of choice for clinically stable patients. Additional innovative treatments have emerged, but their effectiveness and safety must be confirmed.
Collapse
Affiliation(s)
- Bing Han
- Department of Pancreatic and Biliary Surgery, First Clinical Hospital, Harbin Medical University, Harbin 150001, China
| | | | | |
Collapse
|
6
|
Sileikis A, Beisa V, Rutkauskaite D, Misonis N, Strupas K. Management of Bleeding Pseudoaneurysms in Complicated Pancreatitis. VISZERALMEDIZIN 2011. [DOI: 10.1159/000332931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
7
|
|
8
|
Chevallier P, Novellas S, Vanbiervliet G, Staccini P, Le Conte L, Hébuterne X, Bruneton JN. [Transcatheter embolization for endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage]. ACTA ACUST UNITED AC 2007; 88:251-8. [PMID: 17372552 DOI: 10.1016/s0221-0363(07)89811-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Evaluate the efficacy of endovascular embolization for patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage as well as the factors that may influence mortality. MATERIALS AND METHODS. Retrospective study over a 4-year period including a historical cohort of 37 consecutive patients (22 men), with a mean age of 69.2 years (range, 22-93 years). In most cases (54%), the hemorrhage stemmed from a gastrointestinal ulcer. Technical, primary clinical, and secondary clinical success rates, as well as complication rates, were calculated. Several clinical and angiographic parameters were compared to the early mortality rate using Kruskal-Wallis or Fisher tests. RESULTS Technical, primary clinical, secondary clinical success rates, and complication rates were, respectively, 89.2%, 83.8%, 88.9%, and 10.8%. The early mortality rate was 32.4%. The APACHE II and IGS II scores were strongly correlated with mortality (p=0.001 and p=0.003, respectively). CONCLUSION Endovascular embolization in patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage is effective. However, the mortality rate remains high because of the changes in the clinical condition of these patients.
Collapse
Affiliation(s)
- P Chevallier
- Service de d'Imagerie diagnostique et interventionnelle, Hôpotal Archet II, Nice Cedex 03, France.
| | | | | | | | | | | | | |
Collapse
|
9
|
Affiliation(s)
- Gilles Lesur
- Fédération des Spécialités Digestives, Hôpital Ambroise Paré, 92104 Boulogne Cedex, France.
| |
Collapse
|
10
|
Le Moine O, Matos C, Closset J, Devière J. Endoscopic management of pancreatic fistula after pancreatic and other abdominal surgery. Best Pract Res Clin Gastroenterol 2004; 18:957-75. [PMID: 15494289 DOI: 10.1016/j.bpg.2004.06.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Post-operative pancreatic fistulae represent a challenge for all the actors in gastroenterology: for surgeons, because they want to prevent and treat conservatively this complication since re-operation is associated with high morbidity and mortality rates; for radiologists, because they have to provide the best staging and informations without any additional risk; and for endoscopists, because endoluminal treatment is emerging as a safe and effective procedure provided it is performed in highly experienced tertiary centres in the setting of a multidisciplinary approach. Herein, we review the definitions, the causes, the staging and the possible options to prevent or treat post-operative pancreatic fistulae. Special attention is paid to the endoscopic management of this complication: including the relief of ductal obstructions, the stenting of leakages and the drainage of bulging or non-bulging fluid collections. Practical problems and issues are clearly outlined as well as the need for future improvements in staging and management of the patients having such complications.
Collapse
Affiliation(s)
- Olivier Le Moine
- Department of Gastroenterology, ULB-Hôpital Erasme, 808 route de lennik, B-1070 Brussels, Belgium.
| | | | | | | |
Collapse
|
11
|
Affiliation(s)
- Aiden M Callinan
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, and Division of Surgery, University of Sydney, St Leonards, New South Wales, Australia
| | | | | |
Collapse
|
12
|
N/A. N/A. Shijie Huaren Xiaohua Zazhi 2004; 12:1507-1509. [DOI: 10.11569/wcjd.v12.i6.1507] [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] [Indexed: 02/06/2023] Open
|
13
|
Suzuki T, Ishida H, Komatsuda T, Oyaké J, Miyauchi T, Heianna J, Miyashita M. Pseudoaneurysm of the gastroduodenal artery ruptured into the superior mesenteric vein in a patient with chronic pancreatitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:278-282. [PMID: 12767023 DOI: 10.1002/jcu.10170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report the case of a patient with chronic pancreatitis that was complicated by the rare occurrence of a pseudoaneurysm of the gastroduodenal artery that ruptured into the superior mesenteric vein. The patient, a 65-year-old alcoholic man, suddenly experienced hematemesis. Gastroesophagoscopy revealed bleeding from esophageal varices; the hemorrhaging was controlled with sclerotherapy. Sonography identified a 2-cm round anechoic mass at the pancreatic head, and color Doppler imaging revealed turbulent arterial flow within the mass, leading us to the diagnosis of the pseudoaneurysm. CT and angiographic findings generally corresponded with those of sonography and confirmed our diagnosis. The pseudoaneurysm was treated successfully with embolization, and the patient was discharged 10 days after therapy. Follow-up sonography performed 2 months later confirmed the absence of blood flow within the lesion. Color Doppler sonography was very useful for diagnosing the pseudoaneurysm and planning its treatment, and we recommend its routine use in patients with chronic pancreatitis to avoid delays in diagnosing and treating such vascular complications.
Collapse
Affiliation(s)
- Toshio Suzuki
- Center of Diagnostic Ultrasound, Red Cross Hospital, 222-1 Inashirosawa Saruta Kamikitade, Akita 010-1406, Japan
| | | | | | | | | | | | | |
Collapse
|
14
|
Feng DH, Mauro MA. SIR 2003 film panel case 6: hemosuccus pancreaticus secondary to chronic pancreatitis. J Vasc Interv Radiol 2003; 14:803-5. [PMID: 12817051 DOI: 10.1097/01.rvi.0000079994.80153.eb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- David H Feng
- Department of Radiology, University of North Carolina, School of Medicine, Chapel Hill, NC 27599, USA
| | | |
Collapse
|
15
|
Mizutamari H, Masamune A, Asakura T, Nagasaki Y, Satoh A, Sakai Y, Yamagiwa T, Shimosegawa T. A case of hemosuccus pancreaticus associated with hereditary pancreatitis. TOHOKU J EXP MED 2001; 195:191-5. [PMID: 11874252 DOI: 10.1620/tjem.195.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a 25-year-old male with hemosuccus pancreaticus associated with hereditary pancreatitis. He was originally diagnosed as having familial chronic pancreatitis at the age of 12, because his brother was also diagnosed as having pancreatitis. No history of pancreatitis was found in their parents. The patient was admitted because of a growing pancreatic pseudocyst. While he had undergone conservative treatment for the pseudocyst, computed tomography incidentally revealed a pancreatic pseudoaneurysm. Endoscopic examination revealed spontaneous bleeding from the major papilla. Interventional embolization was successfully performed. An R122H mutation in the cationic trypsinogen gene was identified in this patient, his brother, and his mother, indicating that they have hereditary pancreatitis. To our knowledge, this is the first report of hemosuccus pancreaticus associated with hereditary pancreatitis. Mutational screening is useful for the diagnosis of hereditary pancreatitis, especially in patients whose diagnosis is inconclusive based on the traditional clinical criteria.
Collapse
Affiliation(s)
- H Mizutamari
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Obscure digestive bleeding is defined as recurrent bleeding for which no definite source has been identified by routine endoscopic or barium studies. Mucosal vascular abnormality or 'angioectasia' is the most common course of obscure bleeding, especially in elderly patients. Small bowel tumours are more frequent in patients younger than 50 years. However, missed or underestimated upper and lower gastrointestinal lesions at the initial endoscopic investigation may be the source of a so-called obscure intestinal bleeding. The various radiological procedures, including enteroclysis, visceral angiography and CT scan as well as radioisotope bleeding scans have limitations in the case of obscure gastrointestinal bleeding. Recent developments in magnetic resonance imaging are promising. The different methods of enteroscopy have a similar diagnostic yield, reaching approximately 40-65%. Endoscopic cauterization of small bowel angioectasias seems to be efficacious but randomized trials are needed. Efficacy of hormonal therapy is very controversial. The extent of diagnostic and therapeutic strategies must be based on a number of factors including the patient's parameters, bleeding characteristics and also the result of previous work-up.
Collapse
Affiliation(s)
- A Van Gossum
- Department of Gastroenterology, Hôpital Erasme, Route de Lennik, 808, Brussels, 1070, Belgium
| |
Collapse
|