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Z Gastroenterol 2024; 62(10): 1708-1714
DOI: 10.1055/a-2364-4462
Kasuistik

Hemosuccus pancreaticus – Multidisciplinary therapy for a splenic artery aneurysm, ruptured into the pancreatic duct

Hemosuccus pancreaticus – Multidisziplinäre Therapie eines in den Pankreasgang rupturierten Milzarterienaneurysmas
Mikolaj Walensi
1   Department of Vascular Surgery and Phlebology, CONTILIA Group – Heart and Vascular Center, Essen, Germany
,
David Albers
2   Abteilung für Innere Medizin und Gastroenterologie, Elisabeth-Krankenhaus Essen Klinik fur Innere Medizin und Gastroenterologie, Essen, Germany (Ringgold ID: RIN420478)
,
Dani Dakkak
3   Klinik für Innere Medizin und Gastroenterologie, Elisabeth-Krankenhaus Essen Klinik fur Innere Medizin und Gastroenterologie, Essen, Germany (Ringgold ID: RIN420478)
,
Wei Meng
4   Department of Vascular Surgery, Klinikum Oberberg GmbH, Gummersbach, Germany (Ringgold ID: RIN369124)
,
Roland Heesen
5   Department of Angiology, Contilia Group – Heart and Vascular Center, Essen, Germany
,
Kai Nassenstein
6   Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany (Ringgold ID: RIN39081)
,
Michal Piotrowski
7   Department of Emergency Medicine, McMaster University, Hamilton, Canada (Ringgold ID: RIN3710)
,
Iuri Krasniuk
8   Department of Surgery, Städtisches Klinikum Solingen, Solingen, Germany (Ringgold ID: RIN39608)
,
Nikolaos Tsilimparis
9   Department of Vascular and Endovascular Surgery, LMU University Hospital, Munich, Germany
,
Pavlos Drongitis
10   Department of Vascular Surgery and Phlebology, CONTILIA Group - Heart and Vascular Center, Essen, Germany
,
Johannes N. Hoffmann
11   Department of Vascular Surgery and Phlebology, CONTILIA Group - Heart and Vascular Center, Essen, Germany
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Abstract

Background Numerous conditions may lead to gastrointestinal bleeding (GIB). Compared with common causes, hemosuccus pancreaticus (HP) is a scarce and potentially life-threatening condition.

Case presentation We report the case of a 45-year-old female patient who suffered from hematemesis and subsequent hemorrhagic shock. In repeat esophagogastroduodenoscopies, bleeding from the major duodenal papilla was detected. To stop the acute bleeding, an ERCP was performed, and a plastic stent was inserted into the pancreatic duct (PD). Subsequently, MR and CT scans demonstrated a pseudoaneurysm of the splenic artery (SA) with a fistula to the PD. An interventional therapy approach failed due to a highly twisted course of the SA. Thus, the patient underwent surgery with ligation of the SA. The stent from the PD was removed postoperatively, and the patient recovered well. A histological examination of the SA revealed fibromuscular dysplasia. A lifelong ASA therapy was prescribed, and the patient was discharged on the 14th postoperative day in good condition.

Conclusion The diagnosis and treatment of HP might be impeded due to its multiple causes, ambiguous symptoms, and challenging diagnostic verification. Being a potentially life-threatening condition, the knowledge of this rare entity and the provision of multidisciplinary and multimodal therapy are mandatory for the successful treatment of patients with obscure GIB and proven HP.

Zusammenfassung

Hintergrund Zahlreiche Erkrankungen können zu gastrointestinalen Blutungen (GIB) führen. Im Vergleich zu häufigen Ursachen ist das Krankheitsbild des Hemosuccus pancreaticus (HP) eine seltene und potenziell lebensbedrohliche Pathologie.

Falldarstellung Wir berichten über den Fall einer 45-jährigen Patientin, die an Hämatemesis und anschließendem hämorrhagischen Schock litt. Bei wiederholten ÖGD wurde eine Blutung aus der Papilla duodeni major diagnostiziert. Um die akute Blutung zu stoppen, wurde eine ERCP durchgeführt und ein Kunststoffstent in den Pankreasgang (PG) eingeführt. Anschließend konnte mittels MR- und CT-Aufnahmen ein Pseudoaneurysma der Milzarterie (MA) mit einer Fistel zum PG als Ursache diagnostiziert werden. Ein interventioneller Therapieansatz scheiterte an einem stark geschlängelten Verlauf der MA. Daher wurde die Patientin einer Operation mit Ligatur des MA unterzogen. Der Stent aus dem PG wurde postoperativ entfernt und die Patientin erholte sich im Anschluss sehr gut. Es wurde eine lebenslange ASS-Therapie verordnet und die Patientin konnte am 14. postoperativen Tag in gutem Zustand nach Hause entlassen werden.

Schlussfolgerung Die Diagnose und Behandlung eines HP aufgrund vielfältiger Ursachen, der unspezifischen Symptome und der oftmals schwierigen Diagnose verzögert sein. Da es sich um eine potenziell lebensbedrohliche Erkrankung handelt, sind die Kenntnis dieser seltenen Erkrankung sowie die Bereitstellung einer multidisziplinären und multimodalen Therapie für die erfolgreiche Behandlung von Patienten mit unklarer GIB und nachgewiesener HP unerlässlich.

Keywords

hemosuccus pancreaticus - obscure gastrointestinal bleeding - HS - splenectomy - splenic artery aneurysm

Schlüsselwörter

Hemosuccus pancreaticus - obskure gastrointestinale Blutung - HS - Splenektomie - Milzarterienaneurysma


Publication History

Received: 25 May 2024

Article published online:
03 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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