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

Abstract

Chronic pancreatitis with a pseudoaneurysm is an established cause of hemosuccus pancreaticus. We herein describe a patient with chronic alcoholic pancreatitis associated with hemosuccus pancreaticus due to a pseudoaneurysm of the anterior superior pancreaticoduodenal artery rupturing in a pseudocyst of pancreas in the head region. Angiographic embolization was unsuccessful and therefore a laparotomy, ligation, and excision of the pseudoaneurysm with external drainage of pseudocyst were performed. Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding. Contrast-enhanced computed tomography and angiography is diagnostic in the majority of the cases. Surgery is the treatment of choice. Selective angiographic embolization may be helpful in tiding over the emergency until surgery can be performed.

“Hemosuccus Pancreaticus” – Primarily Ultrasound-Guided Successful Intervention Using Transcutaneous Fibrin Glue Application and Histoacryl Injection

“…There are 224 cases of "Hemosuccus pancreaticus" due to pancreatitis reported in the literature [1, 3 -11, 14, 15]. While one fourth of these patients were treated with an interventionally radiological approach [1, 4, 5, 7, 9, 14 -16], three fourths of the subjects underwent surgical intervention [1,4,8,10,11]. Patients with no recognized diagnosis or no appropriate treatment do have a poor prognosis (mortality, approximately 90 %) [2].…”

“…Although angiographic intervention was subsequently attempted to ensure the success of the minimally invasive approach with implantation of a prosthesis in the lienal artery [7,14,18], this was complicated by vascular spasm [11] so that implantation could not be performed and the second application of histoacryl alone led to permanent success. Therefore, we suggest this alternative but feasible and safe method as a possible first interventional step in the therapeutic algorithm or in high-risk patients to achieve definitive cessation of bleeding in lesions such as "Hemosuccus pancreaticus" to avoid more invasive interventions, e. g., interventional angiography [1, 2 -4, 7, 9 -11, 14 -16, 18] or open surgery [1,2,4,8,10,11,18,21]. Further follow-up investigations in this case are recommended.…”

A Rare Cause of Obstructive Jaundice: Superior Mesenteric Artery Pseudoaneurysm

“…Furthermore, associated vascular anomalies can also be revealed, which may be of primary significance for the operating surgeon, and provides a potential means for treatment via transcatheter embolization. [14][15][16] Because of the large size of the pseudoaneurysm of our patient, resulting in direct pressure over the common bile duct and the head of the pancreas and duodenum, endovascular was considered to be the treatment of choice. Only a few cases of pancreatic pseudoaneurysms associated with cholestatic jaundice are being described in the literature.…”

Hemosuccus Pancreaticus as a Rare Complication of Bariatric Surgery

“…As of 2006, our review of the literature uncovered descriptions of approximately 100 cases of hemosuccus pancreaticus ( 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ). Patients may present with anemia, hyperamylasemia, epigastric or left upper quadrant pain, which improves after a pressure-releasing upper or lower GI bleed, and hyperamylasemia ( 4 , 5 ).…”