Hemosuccus pancreaticus pdf
Hemosuccus pancreaticus is a rare but life-threatening cause of upper gastrointestinal bleeding through the main pancreatic duct. We retrospectively reviewed the records of all 51 patients who presented with HP over the last 15 years at our institution between January and December The diagnosis of hemosuccus pancreaticus requires a high level of expertise. Hemosuccus pancreaticus, defined as bleeding from the papilla of Vater via the pancreatic duct, is a rare and challenging cause of intermittent upper GI bleeding predominantly affecting men (male:female ratio 7:1) especially in relation to chronic alcohol intake.
Termed hemosuccus pancreaticus by Sandblom in 1970, hemorrhage from the pancreatic duct into the gastrointestinal tract represents a rare and challenging problem. Image; Published: 30 September 2011; Bleeding from major and minor duodenal papillae due to hemosuccus pancreaticus confirmed with side-view gastroduodenal endoscopy. Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital; and Division of Surgery, University of Sydney, Sydney, New South Wales, Australia. Full Text PDF [1027K] Abstracts References(14) Cited-By(4) We report a 25-year-old male with hemosuccus pancreaticus associated with hereditary pancreatitis. Context Hemosuccus pancreaticus is a rare source of gastrointestinal bleeding, the most frequent cause of which is pancreatitis, followed by tumors, but nearly all these tumors are true neoplasms, and not pseudotumors. Angioembolization is the initial therapy in many cases, but sometimes surgical procedures are mandatory for a definitive treatment. It is often included under hemobilia though some authorities classify it as pseudohemobilia. A 54-year-old man with a history of chronic alcoholic pancreatitis was admitted to hospital for an acute exacerbation.
Hemosuccus pancreaticus is a very rare cause of gastrointestinal bleeding and it should be considered in every patient with history of chronic pancreatitis who presents with acute or intermittent gastrointestinal haemorrhage. Therefore, a car needs one gearing to reach maximum speed but another to reach maximum fuel efficiency at a lower speed. INTRODUCTION:Hemobilia refers to blood in the biliary tree and is a known cause of upper gastrointestinal bleeding. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. A 62-year-old woman who had been followed for a branch duct intraductal papillary mucinous neoplasm visited our emergency room due to severe abdominal pain and bloody discharge. Hemosuccus pancreaticus is defined as intermittent bleeding from the pancreatic duct into the GI tract, usually caused by the rupture of an pseudoaneurysm, which is usually associated with pancreatitis, abdominal surgery, and can result in life-threatening hemorrhage.
1 It is not an exceptional event as it is reported in 5%–10% of patients with chronic pancreatitis and associated hemorrhage. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. Pathophysiology is either from direct rupture of the aneurysm or pseudoaneurysm (PA) into the main pancreatic duct or indirect communication between the artery and duct with the pseudocyst. Management of HP depends on the underlying cause, and surgery or interventional radiology for selective arterial embolization is indicated in most cases. This clinical entity is a difficult diagnosis due to its rarity, intermittent nature of the hemorrhage, and peculiar clinical presentation. Patients present with repeated upper gastrointestinal bleeding that is intermittent but often self-limited. Lippincott Journals Subscribers, use your username or email along with your password to log in.
He had been diagnosed with a cerebral infarction 3 years before admission and had been taking ticlopidine 200 mg twice daily since then. Definitive pancreatoduodenectomy was performed successfully and he had no further gastrointestinal bleeding. Upper digestive endoscopy and angiography during active bleeding can provide the diagnosis. Sign In; Create an Account "Never doubt that a small group of thoughtful, committed citizens can change the world. The most common cause is a splenic artery pseudoaneurysm caused by acute or chronic inflammation of the pancreas. A 45-year-old man was medicated for chronic pancreatitis and gastroduodenal ulcer. Hemosuccus pancreaticus (HP) is a rare and potentially life threatening clinical entity and is described as bleeding from the ampulla of Vater via the pancreatic duct. Methods: We reviewed our experience with management of 17 patients admitted to surgery or gastroenterology units for hemosuccus pancreaticus between 1981 and 2005.
Ruptured splenic artery aneurysm in pregnancy.
The mechanism of hemosuccus pancreaticus typically involves erosion of a tumor or pseudocyst into an arterial lumen leading to bleeding from the pancreatic duct into the ampulla of Vater. It is more common in men and typically presents as epigastric pain radiating to the back coupled with sporadic gastrointestinal bleeding. Abstract Objectives: The purpose of this study was to analyze the diagnostic and therapeutic features of hemosuccus pancreaticus.
Most cases reported in literature are associated with alcoholic chronic pancreatitis. Chronic infection of the pancreas with Brucellosis causing hemosuccus pancreaticus has not been previously reported. Bleeding into the pancreatic duct manifested by blood loss through the ampulla of Vater is known as Hemosuccus pancreaticus. Hemosuccus pancreaticus, a rare clinical condition, is due to passage of blood into the pancreatic duct possibly through a route between an aneurysm of an artery close to the pancreas and/or pancreatic duct, leading to gastrointestinal (GI) bleeding. Hemosuccus pancreaticus after endoscopic ultrasound-guided fine needle aspiration of a pancreatic cyst. We report hemosuccus pancreaticus caused by a microrupture of the splenic artery with arteriosclerosis into the main pancreatic duct without aneurysms or pancreatic cystic lesions. Hemosuccus pancreaticus is a life-threatening condition and should be considered in patients with abdominal pain, gastrointestinal hemorrhage and high serum lipase. In this case, we suspected that the small vessel wall failure due to concomitant pancreatitis of in situ carcinoma was the cause of hemosuccus pancreaticus.
HP is most often diagnosed in patients with chronic pancreatitis, and is usually due to the rupture of an aneurysm in the splenic artery. Although most cases can be managed by angioembolization, surgery plays an important role. The traditional treatment for HP is surgery, although most cases can be managed by angioembolization.
Bleeding occurs when a pseudocyst or tumour erodes into a vessel, forming a direct communication between the pancreatic duct and blood vessel. Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding from the pancreatic duct that is increasingly being identified with the use of computerized tomography (CT) angiogram [–16]. Buy this article and get unlimited access and a printable PDF ($30.00) - Sign in or create a free account. Lower and Farrel first reported that blood was expelled into the duodenum via the main pancreatic duct . It is the least frequent cause of upper gastrointestinal bleeding (1 in 5000) and is usually caused by chronic pancreatitis, pseudo-aneu-rysm, or pancreatic tumors . Hemosuccus pancreaticus in a dog: A rare case of gastrointestinal hemorrhage Abstract A 9-year-old, 5.5-kg (12.12-lb) spayed female Poodle was evaluated due to recurrent seizures and possible diabetes. In a systematic review, the gastroduodenal artery is only involved 16% of the time.
It may present as massive or obscure gastrointestinal bleeding.
Methods: We reviewed our experience with management of 17 patients admitted to surgery or gastroenterology units for hemosuccus pancreaticus between. Hemorrhage from the pancreatic duct, or hemosuccus pancreaticus (HP), is an unusual cause of intermittent gastrointestinal bleeding. He was admitted to our institute because of massive duodenal bleeding and underwent emergent distal gastrectomy. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required. Question: A 35-year-old man, a chronic alcoholic having recurrent episodes of abdominal pain owing to chronic pancreatitis for last 4 years, presented with complains of 5 episodes of melena. Hemosuccus pancreaticus should always be thought of in GI bleed patients with background of chronic pancreatitis or pancreatic pseudo cyst where no other cause of bleeding has been demonstrated. Hemosuccus pancreaticus is an unusual etiology that is characterized by intermittent upper gastrointestinal bleeding from the ampulla of Vater into the duodenum .
ied symptoms, contribution of established morphological examinations (upper digestive endoscopy, computed tomography, and selective digestive angiography), and treatment. A 79-year-old man suffering from recurrent hematemesis and melena from July 1996 consulted several hospitals but the cause of gastrointestinal bleeding was not found. The aim of this paper is to provide a general overview of the topic, highlighting the indications, technique, and important management issues relating to endoscopic management of the various forms of peri-pancreatic fluid collections. Several terms have been used to describe hemorrhage from the pancreatic duct, including wirsumgorrhagia, proposed by Van Kemmel in 1969, the common terminology used in France, or the equivalent hemowirsungia. Hemosuccus pancreaticus, a rare entity, was first coined by Sand Bloom in 1970 on detection of bleeding pancreatic duct in three cases.
Endoscopy during an attack is often rewarding and conventional angiography has a therapeutic role. The standard treatment involves embolization via interventional radiology or a surgical approach. This potentially life-threatening complication of pancreatitis may pose a significant diagnostic and therapeutic dilemma, especially in patients who do not exhibit symptoms such as abdominal pain, jaundice, or GI bleeding. Hemosuccus pancreaticus (HP) refers to hemorrhage arising from the major duodenal papilla via the pancreatic duct, is a rare cause of intermittent upper gastrointestinal bleeding. Case report We report two cases of hemosuccus pancreaticus managed at our institution in the past three years. The patient is a 72-year-old male with a history of severe acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) 15 months earlier.
hemosuccus pancreaticus requires a high clinical suspicious, once the visualization of an active bleeding during an upper digestive endoscopy occurs in the minority of cases. The patient had an uneventful postoperative course and was well at a 7-month follow-up. We present the case of a 61-year-old male with a history of chronic alcohol-related pancreatitis who consulted for melena. Hemosuccus pancreaticus—blood entering the gastrointestinal tract through the pancreatic duct—is a rare and elusive form of gastrointestinal bleeding.
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Hemosuccus pancreaticus, a condition in which blood is expelled into the duodenum via the main pancreatic duct, is a rare cause of acute gastrointestinal bleeding. Hemosuccus pancreaticus (HP) involves bleeding from the papilla of Vater into the duodenum through the pancreatic duct. Six patients, repre-senting 1.5% of the total number of patients undergoing surgery for chronic pancreatitis (n=484), were treated operatively; two other patients were managed using an-giographic embolization. Hemosuccus pancreaticus (HP) defined as bleeding into the pancreatic duct was first described in 1931 by Lower and Farell. The intensity of bleeding ranges from intermittent occult bleeding to massive acute bleeding leading to death. In addition, relative lack of knowledge and rarity of the disease makes the diagnosis even more challenging. Hemosuccus pancreaticus is a rare etiology of obscure gastrointestinal bleeding characterized by bleeding into the pancreatic duct. Furthermore, nearly all pseudotumors of the pancreas and retroperitoneum are inflammatory.
Hemosuccus pancreaticus (HP) is defined as bleeding from the ampulla of Vater via the pancreatic duct and is caused by a bleeding source in the pancreatic parenchyma, pancreatic duct or structures adjacent to the pancreas . Diagnosis is not straight forward and different diagnostic modalities along with high clinical suspicion may be required to demonstrate Hemosuccus pancreaticus.
Results: Fifteen men and two women with a mean age of 57 years presented hemosuccus pancreaticus. The bleeding is usually caused by rupture of a visceral artery aneurysm in chronic pancreatitis . Context Hemosuccus pancreaticus, a rare cause of intermittent upper gastrointestinal bleeding, is usually caused by the rupture of an aneurysm associated with chronic pancreatitis.