Hemosuccus Pancreaticus in the Era of Capsule Endoscopy and Double Balloon Enteroscopy Complicated by Multifocal <i>Mycobacterium chelonae/abscessus</i> Infection

Abstract

Hemosuccus pancreaticus is a rare etiology of obscure gastrointestinal bleeding characterized by bleeding into the pancreatic duct. The diagnosis may be delayed for months to years, due to the episodic nature of bleeding and failure to consider the diagnosis. Patients often undergo multiple endoscopies and radiologic evaluations prior to diagnosis. Incidental gastrointestinal findings may lead to unnecessary endoscopic and surgical interventions. This report describes a patient with hemosuccus pancreaticus diagnosed in the era of video capsule endoscopy and double balloon enteroscopy, whose management was complicated by multifocal Mycobacteria chelonae/abscessus infection.

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

“…4,15 Other major causes include visceral artery pseudoaneurysms, pancreatic cancer, gastrointestinal stromal tumor, post-endoscopic retrograde cholangiopancreatography (ERCP) setting, pancreatic trauma, pancreas divisum, and infections (Table 2). 4,16,17 Notably, visceral artery pseudoaneurysm-related hemosuccus pancreaticus can be encountered in ~10% of cases. 5,[16][17][18] The pseudoaneurysm can involve pancreatic parenchyma as well as adjacent structures.…”

“…4,16,17 Notably, visceral artery pseudoaneurysm-related hemosuccus pancreaticus can be encountered in ~10% of cases. 5,[16][17][18] The pseudoaneurysm can involve pancreatic parenchyma as well as adjacent structures. The involvement of splenic (54%), gastroduodenal (16%), hepatic (11%), and pancreaticoduodenal (11%) arteries has been ascertained.…”