Massive haematemesis--presenting symptoms of cystadenocarcinoma of the pancreas

Abstract

Summary:A 43 year old woman presented with attacks of abdominal pain, haematemesis and hyperamylasaemia. Gastrointestinal X-rays and repeated upper gastrointestinal endoscopy failed to reveal the source ofbleeding. Ultrasound and computed tomographic scan demonstrated a calcified mass in the tail of the pancreas. Surgical exploration revealed a solitary mass in the pancreas and histological examination showed cystadenocarcinoma. The patient died 2 years later because of local recurrence, but haematemesis and melaena did not recur.This case presents an unusual manifestation of cystadenocarcinoma of the pancreas with massive bleeding from the tumour via the pancreatic duct and associated pancreatitis. Other possible reasons for bleeding with cystadenocarcinoma of the pancreas are discussed.

Pseudoaneurysm of the Superior Pancreaticoduodenal Artery, a Rare Cause of Hemosuccus Pancreaticus: Report of a Case

“…Bleeding from the pancreatic duct has been most commonly attributed to visceral artery pseudoaneurysms (40%). 3 However, other unusual causes include pancreatic lithiasis, 2,6,7 pancreatic tumors 8,9 (cystadenocarcinoma and osteoclastoma), arteriovenous malformations, 10 and pancreas divisum with chronic pancreatitis. 11 The incidence of visceral vessel aneurysms, detected by celiac angiography, in cases of chronic pancreatitis has been reported to be as high as 10%.…”

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

“…Other causes of HP are aneurysms, pancreatic tumours (cystadenocarcinoma or osteoclastoma), pancreatolithiasis and iatrogenic or accidental traumas of the pancreas 12–14…”

Tumors of the Pancreatic Body and Tail

“…The less common symptoms are constipation, diarrhoea, abdominal distension, fatigue, early satiety, and in the rare event of functioning tumors, the patient may show signs of hypoglycemia [ 22 ]. Hemorrhagic complications secondary to gastric involvement, portal hypertension, haemobilia, or haemosuccus pancreaticus, can be seen in malignant mucinous neoplasms [ 23 , 24 ]. In rare cases of SPEN, patients have presented with acute abdominal pain due to rupture of the tumor [ 25 ].…”