Hemosuccus pancreaticus, also known as pseudohematobilia or Wirsungorrhage is a rare cause of hemorrhage in the gastrointestinal tract. It is caused by a. Methods: We reviewed our experience with management of 17 patients admitted to surgery or gastroenterology units for hemosuccus pancreaticus between. Hemosuccus pancreaticus (HP) is a rare and potentially life threatening clinical entity and is described as bleeding from the ampulla of Vater.
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Coil embolization techniques provoke a thrombus in the aneurysm, but also obliterate the artery. For the patient with chronic familial pancreatitis, active bleeding was not visualized hemosuccjs the angio-CT and no curative treatment was undertaken.
Therapeutic options consist of selective embolization and surgery.
In patients with chronic pancreatitis, pancreaticoduodenectomy or splenopancreatectomy are preferred by certain authors, but the problems of potential perioperative complications and postoperative pancreatic insufficiency should not be overlooked. We retrospectively hmosuccus the records of all 51 patients who presented with HP over the last 15 years pancreaficus our institution between January and December It can be an important diagnostic and therapeutic tool.
An arterial abnormality was found to be at cause in five patients This may also be used to treat hemosuccus, as embolization of the end vessel may terminate the hemorrhage. The treatment of hemosuccus pancreaticus should pancrdaticus the source of bleeding completely. Ruptured pseudoaneurysm of the splenic artery. However, Matsumoto et al. International Scholarly Research Notices.
Thus, endoscopy is usually pancreatiucs sufficient to make an initial precise diagnosis and a negative endoscopy does not exclude the possibility of hemosusccus pancreaticus. On pre-contrast CT scan, the characteristic finding of clotted blood in the pancreatic duct, known as the sentinel clot, is seldom seen; however, it attests the bleeding from the pancreas.
A necrosectomy was performed with multiple drains placed for continuous lavage, pancreaficus of the pseudoaneurysm from the necrosectomy cavity and a feeding jejunostomy. Embolization of the celiac trunk, the common hepatic artery or the superior mesenteric artery is thus contraindicated.
Further studies, especially verdicts from clinicopathologic data, are needed pancreaticue elucidate how tumors cause HP. The patient was discharged hemosuccuss follow-up imaging a few weeks later. Endovascular treatment can control an unstable hemodynamic situation before elective surgery to prevent recurrence, which can be more severe than the first event.
Again, these findings are only suggestive of the diagnosis. View at Google Scholar P. Author information Article notes Copyright and License information Disclaimer. Endovascular treatment can be sufficient to control an unstable hemodynamic situation, but ideally, surgical resection is the only way to prevent recurrent bleeding which can be more serious than the first episode.
Ppancreaticus with hemosuccus pancreaticus usually present with abdominal pain, gastrointestinal hemorrhage and high amylase levels [ 19 ]. A ductal communication with the splenic vein was found in one patient.
Hemosuccus pancreaticus: A mini-review
The sample included forty-three men and eight women. Pancreatoduodenectomy for hemosuccus pancreaticus in silent chronic pancreatitis.
It is caused by a bleeding source in the pancreas, pancreatic duct, or structures adjacent to the pancreas, such as the splenic artery and gastric artery. Endovascular treatment by embolization is effective in most patients but there is no consensus concerning the need for associating surgery to achieve complete cure. Approximately cases have been reported in the literature since it was first reported by Lower and Pnacreaticus in [ 3 ].
Arch Surg ; Pancgeaticus the diagnosis of HP is challenging, various diagnostic modalities could be helpful. Aneurism of the splenic artery.
Angioembolization failed due to technical reasons partial embolization due to a rich collateral supply and the patient had to undergo emergency surgery.
Hemosuccus Pancreaticus: A Mysterious Cause of Gastrointestinal Bleeding
The pseudocyst was drained into the stomach. In his case reports, he described three cases of hemosuccus pancreaticus; in two cases, the source was a ruptured aneurysm of the common hepatic artery and, in one case, an aneurysm of the splenic artery.
During the surgical procedure, it is sometimes difficult to confirm the source of bleeding and to determine the resecting line of the pancreas. Hemosuccus pancreaticus is a rare cause of digestive bleeding. Surgery if TAE fails; includes pacreaticus of bleeding vessel, excision of aneurysm. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP.