Hemosuccus Pancreaticus: A systematic approach

Diagnostic and Therapeutic Challenges in Hemosuccus Pancreaticus: A Case Report

Hemosuccus pancreaticus, also known as pancreatic pseudoaneurysm, is a rare type of upper gastrointestinal bleeding that originates from the major duodenal papilla or ampulla of Vater and extends into the duodenum via the pancreatic duct. By 2021, only 150 cases had been reported worldwide. Without treatment, the mortality rate can be as high as 90%, but it drops to 25%-37% with intervention. We report a case of a 64-year-old woman who experienced intermittent upper gastrointestinal bleeding over a year. Imaging revealed a hematoma and pseudoaneurysm in the pancreas, which was successfully treated with angiographic embolization. This case highlights the value of a multidisciplinary approach, using advanced imaging and minimally invasive techniques like embolization for effective patient outcomes.

A case of situs inversus totalis with hemosuccus pancreaticus due to intrapancreatic pseudocyst perforation of the common hepatic artery treated with a vascular stent graft

Hemosuccus pancreaticus (HP) is characterized by gastrointestinal bleeding from the papilla of Vater via the pancreatic duct. In this report, we describe a case of HP due to arterial perforation in a pancreatic pseudocyst and discuss the computed tomography (CT) findings and efficacy of stent graft placement. A 64-year-old man with a history of heavy alcohol use, situs inversus totalis, and total gastrectomy was hospitalized with hematochezia. Enhanced CT revealed a pseudoaneurysm in the common hepatic artery (CHA) with mildly high density in the main pancreatic duct. Subsequent CT revealed an enlarged cystic lesion with inflow of contrast medium. Angiography confirmed blood flow from the CHA into the pancreatic pseudocyst, and the patient was diagnosed with HP due to intrapancreatic pseudocyst perforation of the CHA pseudoaneurysm. Coil packing into the pseudocyst failed to block the blood flow, and a covered stent graft was placed into the CHA. The patient had an uneventful clinical course. The identification of a pseudoaneurysm and a high-density area in the main pancreatic duct on enhanced CT and changes in the pancreatic cyst diameter may indicate the acute phase of HP, and stent grafting is an effective treatment for intracystic arterial perforation.

Perihepatic caudate lobe haematoma originating from a pancreatic pseudoaneurysm: a diagnostic dilemma

Despite advances in diagnostic imaging and interventional techniques, pancreatic pseudoaneurysms remain a life-threatening complication of pancreatitis. Presentation varies among patients and may include intra-abdominal, retroperitoneal, or gastrointestinal bleeding and bleeding into the pancreatic or common bile duct. We present a unique case of a 74-year-old man with a history of heavy alcohol consumption who presented with a haematoma surrounding the caudate lobe of the liver. Initially, alcoholic cirrhosis and a ruptured hepatocellular carcinoma were suspected. Therefore, transarterial embolization (TAE) of the caudate branch of the hepatic artery was performed. However, 3 months later, the patient experienced abdominal pain with a lesser sac haematoma and a seemingly interconnected pancreatic cyst. One month later, a pseudoaneurysm appeared in the pancreatic cyst. TAE was successfully performed for the pseudoaneurysm, and the patient showed no signs of recurrence during the 1-year follow-up.

Endoscopic Ultrasound-Guided Glue Embolization for Left Gastric Artery Pseudoaneurysm Presenting as Hemosuccus Pancreaticus After Failed Radiological Intervention

Hemosuccus pancreaticus is characterized by intermittent bleeding from the ampulla of Vater due to the rupture of a pseudoaneurysm. There are significant diagnostic and therapeutic challenges associated with this rare and potentially life-threatening condition. We present a rare case in an 18-year-old man who presented with recurrent episodes of hematemesis and melena due to hemosuccus pancreaticus as a result of a left gastric artery pseudoaneurysm. Initial radiological angioembolization failed because of median arcuate ligament syndrome, and endoscopic ultrasound-guided glue embolization was successfully performed. This case further reinforces the importance of endoscopic ultrasound-guided therapy in the management of pseudoaneurysm after failed radiological treatment.

Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding

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.

Hemosuccus Pancreaticus: Diagnostic Pitfalls of a Rare Condition

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.

Getting Closer to an Underdiagnosed Disease: Hemosuccus Pancreaticus, a Rare Cause of Upper Gastrointestinal Bleeding

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.

Vascular complications of pancreatitis

More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America. Necrotizing pancreatitis accounts for 20%-30% of the cases. One-quarter of the patients with pancreatitis develop vascular complications, which carries a high mortality. This mini-review will address these complications that can help primary care physicians and hospitalists in managing their patients effectively.

The Tale of a Bleeding Tree: A Rare Case of Peripancreatic Variceal Hemorrhage Causing Hemosuccus Pancreaticus

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. It was described by Lawal and Farrel in 1931. This disorder has also been referred to as pseudohemobilia or wirsungorrhagia, caused by bleeding into the pancreatic duct. The rarity of this condition can pose a diagnostic challenge. HP is life-threatening and requires immediate attention. The commonly used treatment modality is coil embolization. Surgery is considered in the case of failed embolization or uncontrolled bleeding. Described below, is a case of a 72-year-old female with a history of chronic pancreatitis who presented with anemia secondary to bleeding peripancreatic varices.

Hemosuccus Pancreaticus: A Serious Complication of Chronic Pancreatitis

Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding that usually presents with melena and abdominal pain. It is defined as a hemorrhage from the ampulla of Vater passing through the main pancreatic duct toward the second portion of the duodenum. Imaging is usually required to establish a diagnosis, and angiography continues to be the gold standard for both treatment and diagnosis. In some instances where bleeding is uncontrolled or if the patient is unstable, surgery may be required. Physicians should have a high index of suspicion, especially in patients with a history of chronic pancreatitis, as this diagnosis is associated with a very high mortality rate if left untreated. We report a case of a 67-year-old male with a known history of chronic pancreatitis and pancreatic pseudocyst who presented with melena and right upper quadrant abdominal pain and was found to have hemosuccus pancreaticus secondary to a gastroduodenal artery bleed. He underwent successful angiographic embolization and was discharged home after ensuring resolution of bleed and improvement in symptoms.

Acute Upper Non-variceal and Lower Gastrointestinal Bleeding

Acute gastrointestinal (GI) bleeding is a common surgical emergency requiring hospital admission and associated with high morbidity and mortality. Appropriate decision-making is essential to make a prompt diagnosis, accurate risk assessment, and proper resuscitation of patients with gastrointestinal bleeding. Despite multiple randomized trials and meta-analyses, there is still controversy on various management issues like appropriate risk stratification, the timing of endoscopy, choosing an appropriate endoscopic, and radiological intervention in these groups of patients. As the usage of nonsteroidal anti-inflammatory drugs, antiplatelet, and antithrombotic agents is common in patients with gastrointestinal bleeding, the physician is challenged with proper management of these drugs. The present review summarizes the current strategies for risk stratification, localization of bleeding source, endoscopic and radiological intervention in patients with acute nonvariceal upper GI, middle GI, and lower GI bleeding.

Hemosuccus Pancreaticus: A Comprehensive Review of Presentation Patterns, Diagnostic Approaches, Therapeutic Strategies, and Clinical Outcomes

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.