Life-Threatening Upper Gastrointestinal Hemorrhage in Hemosuccus Pancreaticus: A Case Report

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.

Haemosuccus pancreaticus and seven episodes of recurrent unlocalised upper gastrointestinal bleeding

“…In addition to the variability of which diagnostic modality provided the final diagnosis, there is also quite a bit of variance with respect to presenting symptoms/signs, as well as physical examination findings. In addition to obvious signs of upper GI bleeding (haematemesis, haematochezia and hypodynamic instability), the presenting findings often correlated well with the location of the pseudocyst and the chronic cause of pancreatitis 9–31. Additionally, we noticed a pattern of historical and radiological findings that were represented among a minority of case studies (as well as our patient), including a history of vascular malformations and pseudoaneurysm/ectasias.…”

“…This broad definition, thus, includes any bleeding source in the pancreas, pancreatic duct or pancreas-adjacent structures (eg, splenic artery) that can bleed into the pancreatic duct 7 8. While it is difficult to reliably estimate the prevalence, the current case series suggests haemosuccus pancreaticus make up <1% of upper GI bleeds 9–31…”

“…To help situate our patient’s presentation within the broader population of those presenting with haemosuccus pancreaticus and understand how to better improve existing evaluation algorithms for upper GI bleeds, we performed a comprehensive literature review of all case studies indexed in PubMed that contained the terms ‘pseudocyst’ and ‘haemosuccus pancreaticus’ (online supplemental table 1; n=24 studies9–31 and 36 patients). Two of the original 26 case studies were excluded because the bleeding was unrelated to pancreatic pseudocysts.…”