Hemosuccus pancreaticus bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of vater is a rare, potentially lifethreatening and obscure cause of upper gastrointestinal bleeding. Hemosuccus pancreaticus hp could be an extremely rare disease. Department of gastroenterology, sardar patel medical college, india. The classic triad presentation of right upper quadrant. Hemosuccus pancreaticus results from three main types of.
The patient has a longstanding history of anemia with a. Hemosuccus pancreaticus hemobilia dieulafoy lesion vascular ectasias aortoenteric fistulae neoplasms. Although hemosuccus pancreaticus hp rarely causes gastrointestinal bleeding, it should be considered in cases of unexplained gastrointestinal bleeding. Hemobilia has been documented since the 1600s, but due to its relative rarity, it has only been more critically examined in recent decades. It commonly presents with hematemesis vomiting of blood or coffee groundlike material andor melena black, tarry stools. Coronal a and sagittal b mip enteric phase images from ct enterography show a hyperattenuating polypoid lesion. Hemosuccus pancreaticus describes the phenom enon of blood entering the gastrointestinal tract through the pancreatic duct, analogous to the more commonly encountered hematuria or hemobilia. It is caused by a bleeding source in the pancreas, pancreatic duct, or structures adjacent to the pancreas, such as the splenic artery, that bleed into the pancreatic duct, which is connected with the bowel at the duodenum, the first part of the small intestine patients with hemosuccus may develop symptoms of. Upper gastrointestinal bleeding ugib is a common medical condition that results in substantial morbidity, mortality, and medical care cost. Endoscopynegative upper gastrointestinal bleeding in a.
It usually occurs as a complication of chronic or acute pancreatitis, with. Ordinarily, bleeding in the pancreatic duct is defined as hp. In 80% of the cases, hemosuccus pancreaticus complicates an underlying pancreatic disease 5, 6. May 07, 2008 hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. Blunt trauma is also a significant cause of hemobilia. An unusual cause of hemobilia diagnosed on eus figure 1. Hemosuccus pancreaticus associated with severe acute. Bleeding into the pancreatic duct manifested by blood loss through the ampulla of vater is known as hemosuccus pancreaticus. Bleeding from major and minor duodenal papillae due to hemosuccus pancreaticus confirmed with sideview gastroduodenal endoscopy, indian journal of gastroenterology, 2011, pp. May 28, 2012 hemorrhage from the pancreatic duct, referred to as hemosuccus pancreaticus or pseudohemobilia, is a rare cause of gastrointestinal gi bleeding. The findings pertaining to hemobilia etiology, investigation, and management techniques were considered and organized by clinicians practiced in hemobilia. Hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. Jb hemobilia is an uncommon condition, but its exact incidence is unknown because minor degrees of hemobilia probably go unrecognized or unreported.
We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. We report the case of an 86yearold woman who had recurrent gastrointestinal bleeding from erosion of an aneurysm of the. Hemosuccus pancreaticus from intraductal rupture of a. Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding. The most common cause is a splenic artery pseudoaneurysm caused by acute or chronic inflammation of the pancreas. Benign malignant predictors of mortality increasing age age 70 yrs concurrent active major organ disease preexisting hospitalization mortality rate 34%. Diagnosis of gastrointestinal bleeding in adults american. Bleeding from major and minor duodenal papillae due to. At present, hp is the least frequent cause of upper gastrointestinal bleeding 11500, but can lead to massive gastrointestinal bleeding, which is potentially life threatening. Department of general medicine, sardar patel medical college, india.
Hemophilia a presenting as hemosuccus pancreaticus. Hemosuccus pancreaticus results from three main types of pancreatic processes. Clinical presentation upper gi bleeding osu center for. A, linear eus from the duodenal bulb showing an 8mm 7mm cysticappearing lesion in the headneck region of the pancreas. Hemosuccus pancreaticus is a very rare cause of upper gastrointestinal bleeding. Hemosuccus pancreaticus from intraductal rupture of a primary. Gastroenterologic and radiologic approach to obscure. Polypoid jejunal lesion in a 53yearold man with positive results from a fecal occult blood test. This potentially lifethreatening complication of pancreatitis may pose a significant diagnostic and therapeutic. Usefulness of endoscopic ultrasound for the diagnosis of. It usually occurs as a complication of chronic or acute pancreatitis, with bleeding from a pseudoaneurysm arising from the peripancreatic arteries 2, 3.
Hemobilia refers to bleeding from andor into the biliary tract and is an uncommon cause of gastrointestinal hemorrhage. Hemobilia refers to blood in the biliary tree and is a known cause of upper gastrointestinal bleeding. Most cases of hemobilia are iatrogenic and caused by procedures involving the liver, pancreas, bile ducts, andor the. 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. It is a rare pathology in humans 7, and it has not been reported in veterinary medicine. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Hemosuccus pancreaticus is the term coined to describe the rare case of bleeding observed to occur through the ampulla of vater. Minor hemobilia often results from local tissue irritation and can typically be frequently managed conservatively.
Hemosuccus pancreaticus as a rare cause of gastrointestinal. Hemosuccus pancreaticus caused by a primary splenic artery aneurysm as a rare cause of gastrointestinal bleeding. Lifethreatening hemobilia is fortunately rare, but mortality as high as 25% has been reported in a large retrospective series. Vascular ectasias hemosuccus ibd diverticular disease peptic ulcer disease esophagitis pancreaticus hemobilia aortoenteric fistula endometriosis gastritis phg, gave nongi sources epistaxis hemoptysis testing for occult blood guaiac based testing hemoglobin identified by pseudoperoxidase. Hemosuccus pancreaticus is an unusual cause of gastrointestinal bleeding. Hemorrhage from the pancreatic duct, referred to as hemosuccus pancreaticus or pseudohemobilia, is a rare cause of gastrointestinal gi bleeding. Hemobilia hemosuccus pancreaticus hemoptysis nasopharyngeal e. Hemosuccus pancreaticus, also known as pseudohematobilia or wirsungorrhage is a rare cause of hemorrhage in the gastrointestinal tract. Benign malignant predictors of mortality increasing age age 70 yrs concurrent active major organ disease preexisting hospitalization mortality rate 34% passing frequent frank blood. Hemosuccus pancreaticus bleeding into pancreatic duct complication of chronic pancreatitis, pseudocysts 9aneurysmpseudoaneurysm of peripancreatic, splenic arteries eroding into pancreatic duct diagnosis difficult 9clinical history and endoscopic appearance of blood coming from papilla 9can be missed with standardviewing endoscope. It is the least frequent cause of upper gastrointestinal bleeding 1 in 5000 and is usually caused by chronic pancreatitis, pseudoaneurysm, or pancreatic. Hemosuccus pancreaticus bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of vater is a rare, potentially lifethreatening and obscure cause of upper. We report a case of hemosuccus pancreaticus in a 68yearold man.
Lifethreatening hemobilia is fortunately rare, but mortality as high as 25% has been reported in a. Hemosuccus pancreaticusblood entering the gastrointestinal tract through the pancreatic ductis a rare and elusive form of gastrointestinal bleeding. A new view of occult and obscure gastrointestinal bleeding. Hemosuccus pancreaticus is a unusual syndrome manifested by hemorrhage into the pancreatic duct and by blood loss through the ampulla of vater. Diagnosis of gastrointestinal bleeding in adults linda l. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required. It is caused by a bleeding source in the pancreas, pancreatic duct, or structures adjacent to the pancreas, such as the splenic artery, that bleed into the pancreatic duct, which is connected with the bowel at the duodenum, the first part of the small intestine.
It is often included under hemobilia though some authorities classify it as pseudohemobilia. Hemosuccus pancreaticus is a very rare cause of gastrointestinal bleeding. Hemosuccus pancreaticus hemobilia hemoptysis oropharyngeal reprinted from gastroenterology clinics of north america, 34, 4, rockey dc, occult gastrointestinal bleeding, 699718, 2005 with permission from elsevier. The patient has a longstanding history of anemia with a causal relation to drinking alcohol. The majority of current hemobilia cases have an iatrogenic cause from either bile duct or liver manipulation. Approximately 150 cases have been reported in the literature since it was first reported by lower and farrell in 1931. Hemosuccus pancreaticus is a rare cause of hemorrhage in the gastrointestinal tract. A case of hemosuccus pancreaticus caused by rupture of an aneurysm of the splenic artery. While it was originally described in 1654 by francis glisson as a cause of death in a patient after a penetrating liver injury, the classic 1948 descriptive caseseries by philip sandblom first used the term hemobilia to describe hemorrhage into the biliary tract after blunt. This may be due to hemorrhage originating in the pancreas, such as ulceration of intrapancreatic gastric. Minor hemobilia can present in various ways, eg blood. Usefulness of endoscopic ultrasound for the diagnosis of hemosuccus pancreaticus hemosuccus pancreaticus, hemorrhage from the papilla of vater via the pancreatic duct, is a rare entity. If bloody fluid is seen emanating from the minor papilla, then bleeding is limited to pan creas alone.
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