Hemosuccus Pancreaticus: A Comprehensive Review of Presentation Patterns, Diagnostic Approaches, Therapeutic Strategies, and Clinical Outcomes

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding caused by bleeding from the ampulla of Vater into the duodenum. HP most commonly results from a rupture of pseudoaneurysms secondary to chronic pancreatitis. The low incidence of HP and the wide spectrum of its clinical presentation poses diagnostic challenges. We present a case of a 39-year-old male with acute-on-chronic pancreatitis resulting in HP and obstructive jaundice due to pancreatic pseudocyst with secondary hematoma. This case highlights the rare occurrence of hypovolemic shock due to massive hemorrhage in HP and the successful management with prompt cardiovascular support and angiographic coil embolization of a bleeding pancreatic pseudoaneurysm.

Section: Discussionmentioning

confidence: 99%

Life-Threatening Upper Gastrointestinal Hemorrhage in Hemosuccus Pancreaticus: A Case Report

Joshi¹,

CA²,

Gada³

et al. 2022

“…The origin of the bleed can be from the duct, the pancreas, or even the structures around the pancreas including the splenic artery and the gastric artery [ 2 ]. According to a Medline search done by Tarar et al, only 123 cases have been reported so far [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the nonspecific features, patients usually undergo extensive workup before a diagnosis of HP is reached. Initial laboratory findings are nondiagnostic and might include elevated bilirubin due to pancreaticobiliary reflux [ 3 ]. Endoscopy mostly helps exclude other causes of GI bleeding.…”

Section: Discussionmentioning

confidence: 99%

Hemosuccus Pancreaticus: A Serious Complication of Chronic Pancreatitis

Nasr¹,

Bhutta²,

Kudaravalli³

et al. 2022

Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding that usually presents with melena and abdominal pain. It is defined as a hemorrhage from the ampulla of Vater passing through the main pancreatic duct toward the second portion of the duodenum. Imaging is usually required to establish a diagnosis, and angiography continues to be the gold standard for both treatment and diagnosis. In some instances where bleeding is uncontrolled or if the patient is unstable, surgery may be required. Physicians should have a high index of suspicion, especially in patients with a history of chronic pancreatitis, as this diagnosis is associated with a very high mortality rate if left untreated. We report a case of a 67-year-old male with a known history of chronic pancreatitis and pancreatic pseudocyst who presented with melena and right upper quadrant abdominal pain and was found to have hemosuccus pancreaticus secondary to a gastroduodenal artery bleed. He underwent successful angiographic embolization and was discharged home after ensuring resolution of bleed and improvement in symptoms.

“…Patients with pseudoaneurysm and pancreatic pseudocyst, benefit from transcystic arterial ligation with cystic drainage, especially for those with bleeding vessels located in the head and body of the pancreas, while distal pancreatectomy is reserved for those with bleeding vessels in the tail of the pancreas [ 11 ]. Overall, surgical treatment is associated with a success rate of about 85% with a mortality rate between 10-15% [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Examination findings were benign except for a body mass index of 17.8kg/m2 (18.5-24.9) and epigastric tenderness. Significant lab findings included white cell count of 11.5k/cmm (reference range 4.5-10), hemoglobin of 13.6k/cmm (12)(13)(14)(15)(16), aspartate aminotransferase (AST) of 25 Unit/L (15-37), alanine aminotransferase (ALT) of 20 Unit/L (7-56), alkaline phosphatase (ALP) of 73 Units/L (15-37), Cr of 0.67mg/dl (0.7-1.3), lipase of >11,000Units/L (73-393), total bilirubin of 1.8mg/dl (0.2-1.0), triglyceride of 96mg/dl . The patient was started on lactated ringers at 250cc/hr.…”

Section: Case Presentationmentioning

confidence: 99%

The Tale of a Bleeding Tree: A Rare Case of Peripancreatic Variceal Hemorrhage Causing Hemosuccus Pancreaticus

Ugonabo¹,

Elghezewi²,

Ezeh³

et al. 2022

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. It was described by Lawal and Farrel in 1931. This disorder has also been referred to as pseudohemobilia or wirsungorrhagia, caused by bleeding into the pancreatic duct. The rarity of this condition can pose a diagnostic challenge. HP is lifethreatening and requires immediate attention. The commonly used treatment modality is coil embolization. Surgery is considered in the case of failed embolization or uncontrolled bleeding. Described below, is a case of a 72-year-old female with a history of chronic pancreatitis who presented with anemia secondary to bleeding peripancreatic varices.