Embolisation of branches of the superior mesenteric artery in the treatment of haemosuccus pancreaticus

Abstract

Haemosuccus pancreaticus (HP) is an uncommon cause of upper gastrointestinal (GI) bleeding, most often intermittent, making it difficult to diagnose, becoming fatal. It usually occurs in patients with chronic pancreatitis and is caused by the rupture of a visceral aneurysm within the main pancreatic duct. The association between pseudoaneurysm formation and pancreatitis is well established. Pseudoaneurysm occurs in 3.5%–10% of pancreatitis cases and its rupture is a rare but life-threatening complication of chronic pancreatitis occurring in 6%–8% of patients with pseudocysts and corresponds to less than 1% of cases of GI bleeding.Its diagnosis is challenging, given the intermittent nature of bleeding. Angiographic therapy is considered the first-choice treatment, especially in patients who are stable haemodynamically. We present a case of embolisation of inferior pancreaticoduodenal branches with polyvinyl alcohol microparticles in the treatment of HP.

Gastrointestinal bleeding caused by rupture of a posterior inferior pancreaticoduodenal artery pseudoaneurysm: A case report

“…Arteriography of the celiac trunk and mesenteric arteries is the most useful diagnostic test for pancreatic pseudoaneurysms, with a sensitivity of 96%. [10] During the treatment of this patient, no pseudoangioma was found on the celiac trunk, superior mesenteric artery, or gastroduodenal artery using angiography. The microcatheter was further inserted into the superior pancreaticoduodenal artery during angiography to identify a pseudoaneurysm located in the posterior branch of the inferior pancreaticoduodenal artery.…”

“…Only duodenal papillary bleeding can be seen in approximately 30% of cases. [10] However, repeated endoscopy improves the detection rate, especially when patients develop symptoms such as hematochezia or hematemesis. An enhanced CT examination of the abdomen facilitates the diagnosis of the disease.…”