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Published on: January 3, 2020
Hemosuccus pancreaticus associated with segmental arterial mediolysis successfully treated by transarterial
Itaru Naitoh1, Tomoaki Ando, Masashi Shimohira
1Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Context:
Hemosuccus pancreaticus, a rare cause of intermittent upper gastrointestinal bleeding, is usually caused by the rupture of an aneurysm associated with chronic pancreatitis. Segmental arterial mediolysis is a rare non-arteriosclerotic, non-inflammatory vascular disease characterized by vacuolization and lysis of the arterial smooth muscle cells. Segmental arterial mediolysis often causes intra-abdominal hemorrhage through aneurysm rupture. To our knowledge, hemosuccus pancreaticus associated with segmental arterial mediolysis has not previously been reported.
Case Report:
A 59-year-old man had suffered from recurrent episodes of epigastric pain and melena. Laboratory data showed mild anemia and an elevated serum amylase level. Upper gastrointestinal endoscopy revealed bloody pancreatic juice exuding from the papilla of Vater. There were no findings suggestive of chronic pancreatitis, such as pancreatic calcification, irregularity of the pancreatic duct and atrophy of the pancreas. Contrast-enhanced computed tomography revealed a large fusiform aneurysm of the middle-distal splenic artery, and dissection of the proximal splenic artery and celiac artery. Leakage of contrast medium from the aneurysm into the main pancreatic duct was also evident. Angiography clearly revealed a fusiform aneurysm of the splenic artery. This was managed successfully by transarterial coil embolization and the patient has subsequently shown no recurrence of epigastric pain or melena.
Conclusion:
Segmental arterial mediolysis is a very rare cause of hemosuccus pancreaticus not associated with chronic pancreatitis. Transcatheter arterial embolization is useful for treatment of ruptured aneurysm associated with segmental arterial mediolysis.
Insights
Segmental arterial mediolysis, a rare vascular condition, can cause hemosuccus pancreaticus (bleeding into the pancreas) without chronic pancreatitis. Transcatheter arterial embolization effectively treated a splenic artery aneurysm in this unique case.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Radiology
Background:
- Hemosuccus pancreaticus typically results from splenic artery aneurysms linked to chronic pancreatitis.
- Segmental arterial mediolysis (SAM) is a rare vascular disease causing arterial weakening and potential hemorrhage.
Observation:
- A 59-year-old male presented with recurrent upper gastrointestinal bleeding and elevated amylase, but lacked typical chronic pancreatitis signs.
- Imaging revealed a splenic artery aneurysm with leakage into the pancreatic duct, alongside dissection of the splenic and celiac arteries.
Findings:
- This case represents the first reported instance of hemosuccus pancreaticus associated with segmental arterial mediolysis.
- The patient's bleeding was successfully managed via transarterial coil embolization of the splenic artery aneurysm.
Implications:
- Segmental arterial mediolysis should be considered in cases of hemosuccus pancreaticus, especially when chronic pancreatitis is absent.
- Transcatheter arterial embolization is a viable and effective treatment for managing aneurysmal rupture secondary to SAM.
