Hemosuccus Pancreaticus (HP), An Uncommon Case Report Of Upper Gastrointestinal Bleeding (UGIB)

Aims Hemosuccus pancreaticus (HP) is a rare and potentially life-threatening upper gastrointestinal bleeding (UGIB) from the ampulla of Vater, usually caused by rupture of a visceral psuedoaneurysm of a peripancreatic vessel through the main pancreatic duct, or by a pancreatic psuedocyst in the context of acute or chronic pancreatitis.

Methods In January 2020, we observed a 67 years-old male admitted to our Digestive Endoscopy Unit, with a medical history of chronic liver disease and chronic pancreatitis secondary to alcohol dependence, owing epigastric pain and recurrent episodes of profuse melena. On examination, the patient showed hemodynamic instability with hypotension, tachycardia and a severe anemia. After resuscitation using reidratation and 2 units of red blood cell transfusions, an emergency upper GI endoscopy was performed and revealed a blood oozing from ampulla of Vater. Contrast-enhanced CT-scan showed multiple calcifications of pancreas, pancreatic duct dilatation and a 3,5 cm. x 2,8 cm. large pseudocystat the pancreas head. CT angiography revealed a 20 mm. saccular pseudoaneurysm originating in the gastroduodenal artery, abutting the head of the pancreas, thus establishing the diagnosis of HP. A percutaneous angiographic coil embolization was carried out successfully, without any complication and with no evidence of further episodes of GI rebleeding.

Results Reports on HP have been quite limited and its diagnosis proved difficult and often delayed. Upper GI endoscopy is frequently non-diagnostic. The development of a pseudoaneurysm occurs by proteolytic enzymatic autodigestion and determines a vessel wall erosion caused in turn by pseudocyst formation and cyst-induced pressure necrosis. This kind of complication is more common in chronic pancreatitis.

Conclusions HP is a very rare cause of UGIB and represents one of the most challenging diagnostic and management dilemmas to physicians. HP caused by arterial aneurysm is conventionally treated surgically, but often it is managed by selective angio-embolization with endovascular procedure effectively and securely.

Citation Labianca O, Sica M, Zulli C et al. eP337 HEMOSUCCUS PANCREATICUS (HP), AN UNCOMMON CASE REPORT OF UPPER GASTROINTESTINAL BLEEDING (UGIB). Endoscopy 2021; 53: S208.

Publication History

Article published online:
19 March 2021