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Ghanem UI, Bael PR, Bakri I, Jaber B, Abu-Zaydeh O, Al-Shawa KN. Pancreatic duct stones treated by Whipple as a last resort: A case report. Int J Surg Case Rep 2024; 115:109286. [PMID: 38277984 PMCID: PMC10837058 DOI: 10.1016/j.ijscr.2024.109286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Chronic Pancreatitis is an irreversible inflammation of the pancreas that can lead to fibrosis and scar formation. Pseudocysts are a late complication of chronic pancreatitis and abdominal pain is the most common presenting complaint. CASE PRESENTATION A 48-year-old male who is a known case of chronic pancreatitis presented to our department complaining of abdominal pain for a duration of three weeks. A CT scan revealed a pseudocyst in the head of the pancreas, stones in the unicate process along with dilatation of the body and tail of the pancreas. CLINICAL DISCUSSION After multiple ERCP failures and considering other endoscopic options, the patient was indicated for the Whipple procedure with Roux-en-y reconstruction. Postoperatively, the patient stayed in the hospital for about a week. He was asymptomatic and well but had an elevated random blood sugar level. He was discharged and recommended to follow up with an endocrinologist. CONCLUSION Whipple procedure can be used for patients with multiple pancreatic duct stones when endoscopic therapies are not effective.
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Affiliation(s)
- Usra I Ghanem
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | - Peter R Bael
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Izzeddin Bakri
- Department of Pathology, Al-Makassed Islamic Charitable Society Hospital, Palestine
| | - Bashar Jaber
- Department of General Surgery, Al-Makassed Islamic Charitable Society Hospital, Jerusalem, Palestine
| | - Omar Abu-Zaydeh
- Department of General Surgery, Al-Makassed Islamic Charitable Society Hospital, Jerusalem, Palestine
| | - Khaled N Al-Shawa
- Department of General Surgery, Al-Makassed Islamic Charitable Society Hospital, Jerusalem, Palestine.
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2
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Kobayashi K, Umekawa Y. Acute pancreatitis leading to hemosuccus pancreaticus with pseudoaneurysm. BMJ Case Rep 2024; 17:e258981. [PMID: 38216162 PMCID: PMC10806885 DOI: 10.1136/bcr-2023-258981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Affiliation(s)
- Keigo Kobayashi
- Department of Internal Medicine, General Incorporated Foundation Kurashiki Medical Center, Kurashiki, Japan
| | - Yasuhiro Umekawa
- Department of Internal Medicine, General Incorporated Foundation Kurashiki Medical Center, Kurashiki, Japan
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3
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Walia D, Saraya A, Gunjan D. Vascular complications of chronic pancreatitis and its management. World J Gastrointest Surg 2023; 15:1574-1590. [PMID: 37701688 PMCID: PMC10494584 DOI: 10.4240/wjgs.v15.i8.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 08/25/2023] Open
Abstract
Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.
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Affiliation(s)
- Dinesh Walia
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anoop Saraya
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Gunjan
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
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4
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Zhou YY, Wang SC, Seak CJ, Huang SW, Cheng HT. Case report: Duodenal obstruction caused by gastroduodenal artery pseudoaneurysm with hematoma: an unusual case and literature review. Front Med (Lausanne) 2023; 10:1198378. [PMID: 37425331 PMCID: PMC10325565 DOI: 10.3389/fmed.2023.1198378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Visceral artery pseudoaneurysm is a rare disease that most commonly occurs in male patients in their 50s, with gastroduodenal artery (GDA) pseudoaneurysm accounting for only 1.5% of these. The treatment options generally include open surgery and endovascular treatment. In 40 cases of GDA pseudoaneurysm from 2001 to 2022, endovascular therapy was the mainstay of treatment in 30 cases, and most of them (77%) were treated by coil embolization. Our case report describes a 76-year-old female patient with a GDA pseudoaneurysm, which was treated by endovascular embolization using liquid embolic agent N-butyl-2-cyanoacrylate (NBCA) alone. This is the first time this treatment strategy has been used for GDA pseudoaneurysm. We demonstrate a successful outcome with this unique treatment. The successful experience of our case may provide a new treatment strategy for this rare disease.
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Affiliation(s)
- Yan-Yuan Zhou
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Chung Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, Chang Gung Medical foundation, New Taipei City, Taiwan
| | - Chen-June Seak
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Shu-Wei Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Hao-Tsai Cheng
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
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5
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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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6
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Cui J, Liu Y, Li J. Gastrointestinal bleeding caused by rupture of a posterior inferior pancreaticoduodenal artery pseudoaneurysm: A case report. Medicine (Baltimore) 2022; 101:e32123. [PMID: 36482622 PMCID: PMC9726413 DOI: 10.1097/md.0000000000032123] [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: 12/13/2022] Open
Abstract
BACKGROUND Gastrointestinal bleeding caused by a ruptured pancreatic pseudoaneurysm is rare, and a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery is especially rare. A 68-year-old man was hospitalized after presenting intermittent black stools and dyspnea accompanied by severe anemia. Angiographic examination revealed that Pseudoaneurysm of the posterior inferior pancreaticoduodenal artery. METHODS Angiography was performed and revealed a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery. Subsequently, a blood transfusion and endovascular embolization were performed. RESULTS The patient's gastrointestinal bleeding stopped, and the hemoglobin level remained stable. During 1 year of follow-up, the patient remained in a generally good condition. CONCLUSION posterior inferior pancreaticoduodenal artery pseudoaneurysmIt is rare and difficult to diagnose, gastrointestinal bleeding is a serious complication, vascular interventional embolization is effective.
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Affiliation(s)
- JinHua Cui
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, China
| | - YaMan Liu
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, China
| | - Jian Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, China
- * Correspondence: Jian Li, Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, No. 36, Nanyingzi Street, Chengde City, Hebei Province 067000, China (e-mail: )
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Kalas MA, Leon M, Chavez LO, Canalizo E, Surani S. Vascular complications of pancreatitis. World J Clin Cases 2022; 10:7665-7673. [PMID: 36158481 PMCID: PMC9372863 DOI: 10.12998/wjcc.v10.i22.7665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- M Ammar Kalas
- Department of Medicine, Texas Tech University Health Center, El Paso, TX 79905, United States
| | - Monica Leon
- Department of General Surgery, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Luis Omar Chavez
- Department of Medicine, Texas Tech University Health Center, El Paso, TX 79905, United States
| | - Eduardo Canalizo
- Department of General Surgery, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Salim Surani
- Department of Medicine, Texas A&M University, Bryan, TX 77807, United States
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Nasr D, Bhutta A, Kudaravalli P, Ionno A, Aswath G. Hemosuccus Pancreaticus: A Serious Complication of Chronic Pancreatitis. Cureus 2022; 14:e25970. [PMID: 35855260 PMCID: PMC9286009 DOI: 10.7759/cureus.25970] [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] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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9
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Kate V, Sureshkumar S, Gurushankari B, Kalayarasan R. Acute Upper Non-variceal and Lower Gastrointestinal Bleeding. J Gastrointest Surg 2022; 26:932-949. [PMID: 35083723 DOI: 10.1007/s11605-022-05258-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Vikram Kate
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | - Sathasivam Sureshkumar
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Balakrishnan Gurushankari
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Raja Kalayarasan
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
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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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Shannon L, Campbell D, Tham TCK, Caddy GR. Diagnostic conundrum: an elusive bleeding source in patient with recurrent gastrointestinal bleeding. BMJ Case Rep 2021; 14:14/7/e242531. [PMID: 34253516 DOI: 10.1136/bcr-2021-242531] [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: 11/09/2022] Open
Abstract
Over a 6-month period, a 69-year-old woman presented with recurrent symptomatic anaemia, melaena and haematochezia. Extensive investigations were carried out, including CT of the abdomen and pelvis, oesophagogastroduodenoscopy, colonoscopy, two capsule endoscopies and two CT angiograms. The lack of active bleeding at the time of both CT angiograms meant a diagnosis was only made following retrospective examination of images by interventional radiology once fresh ampullary bleeding was identified on capsule endoscopy. The unifying diagnosis was haemosuccus pancreaticus given the combination of the left gastric artery pseudoaneurysm, fresh bleeding identified from ampulla and the patient's history of chronic alcohol-related pancreatitis. Subsequent coil embolisation was performed to an optimal result with no recurrence of symptoms to date.
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