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Recurrent gastrointestinal bleeding associated with chronic pancreatitis

A P Jenkins1, M M el-Omar, J C Booth

  • 1Gastrointestinal Laboratory, Rayne Institute, St Thomas' Hospital, London.

Gut
|February 1, 1995
PubMed
Summary

Chronic pancreatitis can cause recurrent upper gastrointestinal bleeding, even with normal gastroscopy. Surgical intervention revealed a splenic artery communicating with the stomach, resolving the bleeding.

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Area of Science:

  • Gastroenterology
  • Vascular Surgery

Background:

  • Recurrent upper gastrointestinal bleeding (UGIB) can be challenging to diagnose.
  • Chronic pancreatitis is a known risk factor for various gastrointestinal complications.

Observation:

  • A 52-year-old male with chronic pancreatitis presented with recurrent UGIB.
  • Initial gastroscopy was unremarkable, but visceral angiography indicated gastric varices.
  • Despite medical management (propranolol) and splenectomy for variceal decompression, bleeding persisted.

Findings:

  • Surgical exploration revealed an inflammatory pancreatic mass in the head, adhered to the posterior gastric wall.
  • The splenic artery was identified within the mass, directly communicating with the gastric lumen via a small perforation.
  • Ligation of the splenic artery successfully halted the gastrointestinal bleeding.

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Implications:

  • This case highlights a rare but critical complication of chronic pancreatitis: pseudoaneurysm or direct arteriogastric fistula formation.
  • It underscores the importance of considering chronic pancreatitis in the differential diagnosis of obscure UGIB, particularly when standard endoscopic evaluations are negative.
  • Advanced imaging and surgical exploration may be necessary for definitive diagnosis and management of such complex vascular complications.