Haemorrhage from pancreatic pseudocysts presenting as upper gastrointestinal haemorrhage

Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus

Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma-haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.

Hemosuccus pancreatitis due to a ruptured splenic artery pseudoaneurysm - diagnosis and endovascular management

Hemosuccus pancreatitis is a rare and potentially fatal cause of upper gastrointestinal bleeding characterized by hemorrhage from the ampulla of Vater via the pancreatic duct. In this case, a patient with chronic pancreatitis on a background of chronic alcoholism is found to have a splenic artery pseudoaneurysm that was bleeding into the pancreatic duct. This was identified on contrast-enhanced computed tomography imaging and successfully managed via microcoil embolization.

Hemosuccus pancreaticus: A mini-review

Determining the cause of obscure bleeding in the gastrointestinal tract is the key in treating the disease. Hemosuccus pancreaticus (HP) could be an extremely rare disease. Ordinarily, bleeding in the pancreatic duct is defined as HP. At present, HP is the least frequent cause of upper gastrointestinal bleeding (1/1500), but can lead to massive gastrointestinal bleeding, which is potentially life threatening. Owing to its rarity, HP is difficult to diagnose, and the mortality rate of HP remains high in various studies. The purpose of this study is to expound on the basic symptoms and mechanisms of HP and to describe a potential significant examination method and treatment for usage in clinical practice.

Pancreatic Pseudocyst Ruptured due to Acute Intracystic Hemorrhage

Rupture of pancreatic pseudocyst is one of the rare complications and usually results in high mortality. The present case was a rupture of pancreatic pseudocyst that could be treated by surgical intervention. A 74-year-old man developed abdominal pain, vomiting, and diarrhea, and he was diagnosed with cholecystitis and pneumonia. Three days later, acute pancreatitis occurred and computed tomography (CT) showed slight hemorrhage in the cyst of the pancreatic tail. After another 10 days, CT showed pancreatic cyst ruptured due to intracystic hemorrhage. Endoscopic retrograde cholangiopancreatography revealed leakage of contrast agent from pancreatic tail cyst to enclosed abdominal cavity. His left hypochondrial pain was increasing, and CT showed rupture of the cyst of the pancreatic tail into the peritoneal cavity was increased in 10 days. CT showed also two left renal tumors. Therefore we performed distal pancreatectomy with concomitant resection of transverse colon and left kidney. We histopathologically diagnosed pancreatic pseudocyst ruptured due to intracystic hemorrhage and renal cell carcinoma. Despite postoperative paralytic ileus and fluid collection at pancreatic stump, they improved by conservative management and he could be discharged on postoperative day 29. He has achieved relapse-free survival for 6 months postoperatively. The mortality of pancreatic pseudocyst rupture is very high if some effective medical interventions cannot be performed. It should be necessary to plan appropriate treatment strategy depending on each patient.

Hemorrhage into pancreatic pseudocyst

We report a patient whose upper abdominal pain was due to an alcoholic pancreatic pseudocyst with hemorrhage. CT showed a gradually enhancing pancreatic pseudocyst about 6 cm in diameter. It exhibited hyposignal intensity on T2-weighted images and hypersignal intensity on T1-weighted images. Enlargement of the pancreatic pseudocyst was thought to be attributable to hemorrhage into the pancreatic pseudocyst. Angiography revealed a pseudoaneurysm in the anterior superior pancreaticoduodenal (ASPD) artery. Selective transcatheter arterial embolization (TAE) of the ASPD artery stopped the bleeding and his abdominal pain lessened. After 1 month, the diameter of the pseudocyst was reduced to about 3 cm and it showed hypersignal intensity on T2-weighted images and hyposignal intensity on T1-weighted images. TAE was considered to be a minimally invasive, highly effective treatment in this patient with hemorrhage into a pancreatic pseudocyst.