A Unique Case of Hematemesis in a 17-Year-Old Female

Abstract

Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding (GIB) that should be considered in a patient with a history of pancreatitis and GIB. A 17-year-old female presented with nausea followed by an episode of hematemesis. Fourteen weeks prior to presentation, she had 3 episodes of vomiting within a week. Six weeks prior to presentation, she developed abdominal pain and was diagnosed with acute idiopathic pancreatitis. Computed tomography (CT) revealed a cystic lesion arising in the gastroduodenal artery (GDA), and coil embolization was performed. There are no reported cases of HP in an adolescent with acute idiopathic pancreatitis.

Hemosuccus Pancreaticus Following Acute Pancreatitis in a 12-years-old Boy Secondary to Pancreatic Pseudoaneurysm Treated With Endovascular Coil Embolization

“…An EGD may rule out other causes like peptic ulcers, gastritis, or gastric or esophageal varices and may show bleeding from the papilla. The bleeding may be intermittent due to clot formation in the main duct ( 5 ) and may not be observed on EGD, as in our patient. Doppler ultrasound can visualize ANCs and pseudoaneurysms of the arteries; however, it may be limited by restricted sonographic windows and operator dependence ( 9 ).…”

“…The gastroduodenal, pancreaticoduodenal, and hepatic arteries may also be involved. Patients may present with melena, hematemesis, and anemia ( 5 ). Other symptoms include intermittent epigastric pain, elevation of liver enzymes, jaundice (likely related to obstruction of the common bile duct and pancreatic duct by blood), nausea, and nonbloody emesis.…”

“…It occurs mainly in adults, accounting for about 1 of 1500 cases of upper gastrointestinal bleeding ( 2 ). Only a few cases have been reported in children, all associated with pancreatitis ( 3 – 5 ). To our knowledge, no cases have been reported in the pediatric literature from the United States.…”

Hemosuccus pancreaticus: A mini-review

“…The age of onset is widely distributed; the mean age range of patients with HP is from 32 to 36 years [ [13] , [14] , [15] ]. In terms of sex, men have a higher risk of developing HP than women.…”

“…A pancreatic pseudocyst possesses a significant relationship with the pancreatic duct, and bleeding in the gastrointestinal tract may also occur entirely through this route [ 31 ]. According to Zuchelli et al, bleeding is intermittent owing to clot formation in the main pancreatic duct [ 14 ].…”