Spontaneous Pancreatic Hemorrhage: Successful Conservative Management in Two Cases

BACKGROUND Spontaneous pancreatic and peripancreatic hemorrhage (SPH) is a rare subtype of spontaneous retroperitoneal hemorrhage. With diverse clinical manifestations and no specific presentations, early diagnosis of SPH becomes challenging. Patient-specific underlying causes and vital signs guide the SPH treatment approach. CASE REPORT Case 1: A 39-year-old man reported unexplained hypogastralgia at the emergency department (ED). An abdominal MRI revealed a mixed hematoma and cystic lesions between the pancreatic head and descending duodenum, attributed to ruptured mucinous cystic neoplasms. Extensive hematoceles were identified around the liver and abdominal pelvis on an enhanced CT scan. After undergoing fasting, rehydration, proton pump inhibitor and somatostatin intravenous injections, and peritoneal puncture, his condition improved. He was discharged nine days post-admission. Case 2: A 44-year-old man arrived at the ED with back pain and right upper quadrant pain. Enhanced CT indicated peritoneal fluid and a hematoma between the pancreatic head and descending duodenum. He initially received conservative treatment. However, on the eighth day, he reported recurrent abdominal pain. Follow-up CT showed an enlarged hematoma and gastric content accumulation. The patient was fasted and put on parenteral nutrition, and by the 37th day of hospitalization, he had fully recovered and was discharged. Both patients, having stable hemodynamics, fully recovered following conservative management, with no surgical intervention required. CONCLUSIONS Given its varied clinical presentations, SPH can easily be misdiagnosed. However, successful conservative management can lead to full recovery, as demonstrated in these case reports.