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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Abstract Hemosuccus pancreaticus bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of Vater is a rare, potentially life-threatening and obscure cause of upper gastrointestinal bleeding. However, the pancreatic duct orifice is located on the side pancreahicus the duodenum, meaning that it can be missed on forward-viewing endoscopy.

View at Google Scholar S. She was found to have severe anemia and a high serum lipase. Doppler ultrasound or dynamic ultrasound could be used to find vascular abnormalities. Prompt initial angiography can rapidly confirm the diagnosis. It is important to know the other two rare causes of extra luminal source of gastrointestinal bleeding into the duodenum which can be missed easily and can be life-threatening.

Although the postoperative course was difficult, the patient recovered slowly over a period of 34 days and was well pancreaticuss a month follow-up. The former is termed Wirsungorrhage pancreatjcus the latter is termed Santorinirrhage.

Several mechanisms could be involved: Upper gastrointestinal endoscopy showed blood ehmosuccus the stomach and duodenum with erosions in the body and antrum of the stomach. 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.


The diagnosis of hemosuccus pancreaticus can be difficult to make. New modes of therapy, such as EUS-guided angiotherapy, endoscopic stenting, or clipping apncreaticus tamponade, need to be tested in further studies.

Contrast-enhanced CT scan of the abdomen is an excellent modality for demonstrating the pancreatic pathology and can also demonstrate features of chronic pancreatitis, psuedocysts and pseudoaneurysms. But an astute clinician should consider hemosuccus pancreaticus in the differential diagnosis of all cases of obscure upper gastrointestinal bleeding, particularly associated withacute or chronic pancreatitis. Bleeding from the pancreatic duct into duodenum via the ampulla of Vater.

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Hemosuccus pancreaticus: A mini-review

Both of our patients presented with increased abdominal pain and features of an upper gastrointestinal hemorrhage. The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.

Pancreatic trauma may result in HP. Nemosuccus hemorrhage associated with a pseudocyst in chronic pancreatitis: The most common cause is a pseudoaneurysm of the peripancreatic arteries due to acute or chronic pancreatitis [ 12 ]. Hemosuccus pancreaticus”—primarily ultrasound-guided successful intervention using transcutaneous fibrin glue application and histoacryl injection.

The hemorrhage is usually intermittent, repetitive and, most often, not severe enough to cause hemodynamic instability despite the usual arterial origin of bleeding.

A fistulous communication between the pancreatic duct and the splenic vein was found intraoperatively in this case, which is very rare and unusual. Intrahepatic, extrahepatic like gall bladder or bile duct. Open in a separate window. pancreaticuss

Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding

Rarely the bleeding is not channeled into the bowel from the main pancreatic duct or hemoeuccus of Wirsungbut rather comes from the accessory pancreatic duct or duct of Santorini. Intraoperative blood loss was 1. Hemosuccus pancreaticus after penetrating trauma to the abdomen.


Thus, CT scan remains an important diagnostic modality, which may help allow pancreticus therapeutic interventions.

On clinical examination, he had profuse sweating, hypotension, tachycardia, severe pallor and mild tenderness in the epigastrium. Conclusions HP is a rare and potential life-threatening cause of gastrointestinal bleeding.

Aneurysm is also often associated with HP; however, a causal relationship between them has not been established yet [ [4][5][6][7] ]. Hemosuccus pancreaticus bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of Vater is a rare, potentially life-threatening and obscure cause of upper gastrointestinal bleeding. Non-surgical treatment Eradicating the source of bleeding is the only way to cure HP.

Langenbecks Arch Surg ; When the pseudoaneurysm is located in the head of the pancreas, surgical resection is associated with increased mortality and morbidity rates, and independent angioembolization has been proposed as the recommended treatment modality of choice [ 13 ]. Coil embolization techniques provoke a thrombus in the aneurysm, but also obliterate the artery. Pseudoaneurysm occurs in 3.

Hemosuccus pancreaticus complicating chronic pancreatitis: Drainage of the pancreatic pseudocysts associated with arterial ligation is particularly effective and is associated with fewer complications of infection and necrosis compared with aggressive surgery [ 21pabcreaticus — 27 ]. This potentially life-threatening complication of pancreatitis may pose a significant diagnostic and therapeutic dilemma, especially in patients who do not exhibit symptoms such as abdominal pain, jaundice, or GI bleeding.