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Case Report
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| Rare presentation of a massive intermittent upper gastrointestinal bleed | ||||||
| Bonnie Patek1, Matthew Sullivan1, Shashin Shah2 | ||||||
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1DO, Internal Medicine Resident, Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
2MD, Department of Gastroenterology, Lehigh Valley Health Network, Allentown, PA, USA. | ||||||
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| How to cite this article |
| Patek B, Sullivan M, Shah S. Rare presentation of a massive intermittent upper gastrointestinal bleed. Int J Case Rep Images 2017;8(1):30–35. |
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Abstract
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Introduction:
Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding defined as bleeding from the ampulla of Vater through the main pancreatic duct, commonly caused by a ruptured aneurysm in the setting of acute or chronic pancreatitis. Bleeding is often intermittent and repetitive, but can be massive. Endoscopy rarely reveals active hemorrhaging.
Case Report: We present a 35-year-old male with complaints of progressive fatigue and generalized weakness over two weeks. He denied melena, hematochezia, and hematemesis. History revealed prior alcohol abuse and hospitalization for pancreatitis. Laboratory studies revealed hemoglobin of 2.8 g/dL. Initial esophagogastroduodenoscopy (EGD) revealed actively bleeding mass at the major papilla and absence of gastric/esophageal varices. Colonoscopy revealed no pathology. Bleeding continued and patient developed mild epigastric tenderness. Repeat EGD revealed a clean based ulcer in the distal esophagus and thickening of the duodenal mucosa, but no bleeding. Duodenal biopsies showed signs of chronic inflammation. Abdominal computed tomography scan revealed pancreatitis and splenic artery pseudoaneurysm. Patient underwent an abdominal aortogram, revealing an 8 mm splenic artery pseudoaneurysm with no active bleeding. The pseudoaneurysm was embolized and repeat imaging confirmed no residual pseudoaneurysm. Conclusion: Pseudoaneurysm resulting from a pseudocyst secondary to pancreatitis forms most commonly in the splenic artery. Mortality can be as high as 90–100% if left untreated. Although rare, hemosuccus pancreaticus should be included in the differential diagnosis for any patient presenting with severe anemia, in the absence of endoscopically visualized bleeding and with a history of pancreatitis. | |
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Keywords:
Hemosuccus pancreaticus, Pancreatitis, Splenic artery pseudoaneurysm, Upper gastrointestinal bleeding
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Author Contributions
Bonnie Patek – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Matthew Sullivan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Shashin Shah – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2017 Bonnie Patek et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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About The Authors
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