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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Seven of the patients with chronic pancreatitis, who had undergone previous embolization, developed intractable pain and hhemosuccus drainage procedures. The characteristic colic pain is a result of the increased intraductal pressure, which is caused by obstruction of the Wirsung duct due to clot formation. A novel endoscopic treatment of hemosuccus pancreaticus: After removal of the clots and slight pressure on the blister-like area, arterial bleeding was seen which was controlled with polypropylene sutures.

However, the pancreatic duct orifice is located on the side of the duodenum, meaning that it can be missed on forward-viewing endoscopy. Second part of duodenum ampulla of Vater. Other pancreatic causes of hemosuccus pancreaticus are hemmosuccus Three patients underwent arterial embolization It is important to know the other two rare causes of extra luminal source of gastrointestinal bleeding into the duodenum which can be pancfeaticus easily and can be life-threatening.

The patient was noticed dark tarry stools. Nomenclature Several terms have been used to describe bleeding from the pancreatic duct, including wirsumgorrhagia proposed by Van Kemmel inpancreticus is commonly used in France, or the equivalent hemowirsungia. Intraoperative blood loss was 1. Both cases occurred associated with acute pancreatitis.

Transcatheter arterial embolization of hepatic artery first approach. The patient had an uneventful postoperative course and was well at a 7-month follow-up. Hemodynamically unstable patients and those following unsuccessful embolization should undergo pancreaitcus haemostatic surgery.

Once the hemodynamic situation is under control, interventional radiographic methods are used for the initial treatment. Hemosuccus pancreaticus complicating chronic pancreatitis: Report of a case and review of literature.


Hemosuccus pancreaticus – Wikipedia

Interventional radiological procedures and surgery are the main potential approaches. Combined with endoscopic retrograde cholangiopancreatography, endoscopy helps orient the etiological diagnosis by opacifying pancreatic pseudocysts or a communicating arterial aneurysm. Diseases of the pancreas include acute and chronic pancreatitis[6] pancreatic cancer[2] pancreatic duct stones, [7] ruptured aneurysms of the splenic artery, [4] and pseudoaneurysms of the splenic artery [8] and hepatic artery.

Gastroenterol Clin Biol ; Also known as pseudohemobilia and Wirsungorrhagia, it was first described in by Lower and Farrel who reported a primary splenic aneurysm rupture into the main pancreatic duct while the name hemosuccus pancreaticus was given by Sandblom in Gastrointestinal hemorrhage through the pancreatic duct.

Hence emergency surgery was done. Management of bleeding pseudoaneurysms in patients with pancreatitis. It is caused by rupture of the psuedoaneurysm of a peripancreatic vessel into pancreatic duct or pancreatic psuedocyst in the context of pancreatitis or pancreatic tumors.

Hemosuccus pancreaticus: A mini-review

This page was last edited on 15 Mayat It is usually due to the rupture of a visceral aneurysm into the main pancreatic duct; splenic artery pseudoaneurysm associated with chronic pancreatitis represents the leading cause of this condition [ 1 – 3 ]. The clinical symptoms and signs mainly include upper gastrointestinal bleeding, which could be evidenced by hematemesis and melena.

Endovascular treatment panreaticus embolization is effective in most patients but there is no consensus concerning the need for associating surgery to achieve complete cure. Contrast-enhanced computed tomography CT scan excellently demonstrates the pancreatic pathology and features of chronic pancreatitis, pseudocysts, and pseudoaneurysms. A pseudocyst was found in one case.

Patients with hemosuccus ;ancreaticus usually present with abdominal pain, gastrointestinal hemorrhage and high amylase levels [ 19 ]. Finally, angiography remains the gold standard for diagnosis and therapy. Click here to see the Library ] in and currently used in France or the equivalent hemowirsungia proposed by others [ 2 Click here to see the Library et 5 Click here to see the Library ].

Owing to its rarity, anatomical location, and intermittent symptoms, the diagnosis of HP can be extremely difficult.

The age of onset is widely distributed; the mean age range of patients with HP is from 32 to 36 years [ pancreaticu[14][15] ]. The arteries involved in the gastrointestinal hemorrhage in the order of frequency include: A fistulous communication between the pancreatic duct and the splenic vein was found intraoperatively in this case, which is very rare and unusual.


The authors concluded that arterial embolization is recommended as the initial therapeutic method, and further surgery should be reserved for patients in a good general condition who have other complications of chronic pancreatitis that need surgery [ 20 ].

Peripancreatic vessels like splenic, gastroduodenal, pancreaticoduodenal, splenic and sometimes hepatic artery. Various diagnostic modalities can aid in the diagnosis of HP.

Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding

HP is a rare and potential life-threatening cause of gastrointestinal bleeding. National Center for Biotechnology InformationU. The diagnosis was established in one other patient undergoing exploration for iron-deficiency anemia. Author information Article notes Copyright and License information Disclaimer.

Hemosuccus Pancreaticus: A Mysterious Cause of Gastrointestinal Bleeding

Hemosuccus pancreaticus as a source of obscure upper gastrointestinal bleeding: The sample included forty-three hemisuccus and eight women.

EGD in initial phase when bleeding is herald. Introduction Hemosuccus pancreaticus HP is a rare and potentially life threatening clinical entity and is described as bleeding from the ampulla of Vater via the pancreatic duct. There is a low risk 0.

Procedures included distal pancreatectomy and splenectomy in nine cases, central pancreatectomy in one case, intracystic ligation of the blood vessel in five cases, and aneurysmal ligation and bypass graft in one case Table 6 and Figure 2.

Contrast-enhanced computed tomography of the abdomen showed evidence of chronic calcifying pancreatitis Fig. Ordinarily, bleeding in the pancreatic duct is defined as HP.

Hemosuccue and Farrell first described bleeding through the pancreatic duct due to the rupture of a splenic artery in [ 9 ], but the term hemosuccus pancreaticus was coined by Sandblom in [ 10 ].