Haemosuccus pancreaticus als seltene Erstmanifestation einer chronischen Pankreatitis

Abstract

Haemosuccus pancreaticus is an unfrequent but known cause of an upper gastrointestinal bleeding. Pathogenesis of spontaneous severe hemorrhage of the pancreatic duct includes chronic pancreatitis generated pseudocysts or aneurysms of the visceral arteries. We present two cases of severe spontaneous gastrointestinal bleeding as a first manifestation of chronic pancreatitis, in which the diagnosis chronic pancreatitis was not known and the patients denied any gastrointestinal symptoms in their medical history at the time of hemorrhage.

Kehr's sign – a rare cause: Spontaneous phrenic artery rupture

“…Further aetiological factors contributing to visceral artery disease include atherosclerosis, fibromuscular dysplasia and pancreatitis. 16 Although visceral artery aneurysms are often asymptomatic, 8 rupture can result in massive, even life-threatening, gastrointestinal bleed, 13 as exemplified by cases in the literature of haemosuccus pancreaticus 11,[17][18][19] and haematemesis. pancreaticoduodenal, gastroduodenal, superior mesenteric, inferior mesenteric and colic arteries) show that these present mostly in middle-aged men as unexplained abdominal pain with other gastrointestinal or systemic associations that vary between the individual arteries; for example, gastroduodenal artery aneurysms were found to be related to pancreatitis and biliary disease; superior mesenteric artery aneurysms were associated with hypertension and endocarditis.…”

“…Some articles have reported congenital aneurysms involving anomalous visceral arteries of the celiomesenteric trunk; 7 others describe multiple congenital aneurysms associated with connective tissue/ vasculitic disorders such as Ehler Danlos, polyarteritis nodosa, 14 Takayasu's arteritis 15 and Wegener's granulomatosis. 16 Although visceral artery aneurysms are often asymptomatic, 8 rupture can result in massive, even life-threatening, gastrointestinal bleed, 13 as exemplified by cases in the literature of haemosuccus pancreaticus 11,[17][18][19] and haematemesis. 19 Such rare, spontaneous intra-abdominal bleeds have been termed abdominal apoplexy.…”

“…The splenic artery is reported to be the visceral artery most commonly affected by aneurysmal dilatation, whereas the coeliac trunk 8 and the inferior mesenteric artery 9,10 are the least involved. Further aetiological factors contributing to visceral artery disease include atherosclerosis, fibromuscular dysplasia and pancreatitis 6,11,12 …”

“…Although visceral artery aneurysms are often asymptomatic, 8 rupture can result in massive, even life‐threatening, gastrointestinal bleed, 13 as exemplified by cases in the literature of haemosuccus pancreaticus 11,17–19 and haematemesis 19 . Such rare, spontaneous intra‐abdominal bleeds have been termed abdominal apoplexy 20,21 .…”

Die chirurgische Therapie der oberen gastrointestinalen Blutung – Konzepte und zeitliche Planung

“…B. bei Einblutung in eine Pankreaspseudozyste mit Ausbildung einer zystoduktalen Fistel) und Gefäßanomalien wie z. B. das Pseudoaneurysma von Trunkusgefäßen oft verkannt und stellen hohe Anforderungen an Diagnostik und Therapie [2].…”