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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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Ackermann TG, Gao H, Croagh DG. Multimodal treatment of refractory haemorrhage from haemosuccus pancreaticus. ANZ J Surg 2021; 92:859-861. [PMID: 34355841 DOI: 10.1111/ans.17124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Travis George Ackermann
- Upper Gastrointestinal/Hepatobiliary and General Surgery Unit, Monash Health, Clayton, Victoria, Australia
| | - Hugh Gao
- Upper Gastrointestinal/Hepatobiliary and General Surgery Unit, Monash Health, Clayton, Victoria, Australia
| | - Daniel Gerald Croagh
- Upper Gastrointestinal/Hepatobiliary and General Surgery Unit, Monash Health, Clayton, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia
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Abu Jhaisha S, Brozat JF, Hohlstein P, Wirtz TH, Hose J, Bündgens L, Keil S, Trautwein C, Koch A. Hemosuccus Pancreaticus and Obstructive Jaundice: Two Rare Complications of Chronic Pancreatitis Treated by Arterial Embolization. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:961-963. [PMID: 33728615 DOI: 10.1055/a-1381-8610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The formation of a peripancreatic pseudoaneurysm is a rare and serious complication of chronic pancreatitis. In this report, we present the case of a 56-year-old male with a history of alcohol-related chronic pancreatitis resulting in both hemosuccus pancreaticus and obstructive jaundice due to a pseudoaneurysm of the gastroduodenal artery that was treated successfully by angiographic coiling.
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Affiliation(s)
| | | | | | - Theresa H Wirtz
- Department of Medicine III, University Hospital Aachen, Germany
| | - Josephine Hose
- Department of Medicine III, University Hospital Aachen, Germany
| | - Lukas Bündgens
- Department of Medicine III, University Hospital Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Germany
| | | | - Alexander Koch
- Department of Medicine III, University Hospital Aachen, Germany
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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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Rammohan A, Palaniappan R, Ramaswami S, Perumal SK, Lakshmanan A, Srinivasan UP, Ramasamy R, Sathyanesan J. Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre. ISRN RADIOLOGY 2013; 2013:191794. [PMID: 24959558 PMCID: PMC4045512 DOI: 10.5402/2013/191794] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 01/08/2013] [Indexed: 12/17/2022]
Abstract
Background. Hemosuccus pancreaticus (HP) is a very rare and obscure cause of upper gastrointestinal bleeding. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Methods. We retrospectively reviewed the records of all patients who presented with HP over the last 15 years at our institution between January 1997 and December 2011. Results. There were a total of 51 patients with a mean age of 32 years. Nineteen patients had chronic alcoholic pancreatitis; twenty-six, five, and one patient had tropical pancreatitis, acute pancreatitis, and idiopathic pancreatitis, respectively. Six patients were managed conservatively. Selective arterial embolization was attempted in 40 of 45 (89%) patients and was successful in 29 of the 40 (72.5%). 16 of 51 (31.4%) patients required surgery. Overall mortality was 7.8%. Length of followup ranged from 6 months to 15 years. Conclusions. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition.
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Affiliation(s)
- Ashwin Rammohan
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
| | - Ravichandran Palaniappan
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
| | - Sukumar Ramaswami
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
| | - Senthil Kumar Perumal
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
| | - Anand Lakshmanan
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
| | - U P Srinivasan
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
| | - Ravi Ramasamy
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
| | - Jeswanth Sathyanesan
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India
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Vimalraj V, Kannan DG, Sukumar R, Rajendran S, Jeswanth S, Jyotibasu D, Ravichandran P, Balachandar TG, Surendran R. Haemosuccus pancreaticus: diagnostic and therapeutic challenges. HPB (Oxford) 2009; 11:345-50. [PMID: 19718363 PMCID: PMC2727089 DOI: 10.1111/j.1477-2574.2009.00063.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 03/24/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Haemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. The objective of our study was to highlight the challenges in the diagnosis and management of HP. METHODS The records of 31 patients with HP diagnosed between January 1997 and June 2008 were reviewed retrospectively. RESULTS Mean patient age was 34 years (11-55 years). Twelve patients had chronic alcoholic pancreatitis, 16 had tropical pancreatitis, two had acute pancreatitis and one had idiopathic pancreatitis. Selective arterial embolization was attempted in 22 of 26 (84%) patients and was successful in 11 of the 22 (50%). Twenty of 31 (64%) patients required surgery to control bleeding after the failure of arterial embolization in 11 and in an emergent setting in nine patients. Procedures included distal pancreatectomy and splenectomy, central pancreatectomy, intracystic ligation of the blood vessel, and aneurysmal ligation and bypass graft in 11, two, six and one patients, respectively. There were no deaths. Length of follow-up ranged from 6 months to 10 years. CONCLUSIONS Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. Diagnosis is based on investigations that should be performed in all patients, preferably during a period of active bleeding. These include upper digestive endoscopy, contrast-enhanced computed tomography (CECT) and selective arteriography of the coeliac trunk and superior mesenteric artery. Contrast-enhanced CT had a high positive yield comparable with that of selective angiography in our series. Therapeutic options consist of selective embolization and surgery. Endovascular treatment can control unstable haemodynamics and can be sufficient in some cases. However, in patients with persistent unstable haemodynamics, recurrent bleeding or failed embolization, surgery is required.
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Affiliation(s)
- Velayutham Vimalraj
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Devy Gounder Kannan
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Ramaswami Sukumar
- Department of interventional radiology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Shanmugasundaram Rajendran
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Satyanesan Jeswanth
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Damodaran Jyotibasu
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Palaniappan Ravichandran
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Tirupporur Govindaswamy Balachandar
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
| | - Rajagopal Surendran
- Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College HospitalChennai, Tamilnadu, India
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Abstract
Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding from the duct of Wirsung into the duodenum via the ampulla of Vater. Hemosuccus pancreaticus is difficult to diagnose because the bleeding is usually intermittent, and the clinical findings are often discordant. Patients present with pain, either left upper quadrant or epigastric, and bleeding, which may present as melena, bright red blood per rectum, or even shock, if the hemorrhage is severe. Hemosuccus pancreaticus is usually caused by rupture of a pseudoaneurysm of a peri-pancreatic artery, often the splenic artery, in the setting of pancreatitis; other causes are very rare. In this report, for the first time to our knowledge, we present a case of hemosuccus pancreaticus that occurred as a complication of bariatric surgery.
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