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Pancreatoduodenectomy for hemosuccus pancreaticus in silent chronic pancreatitis
J P Arnaud1, R Bergamaschi, V Serra-Maudet
1Department of Visceral Surgery, University of Angers, France.
Insights
Hemorrhage is a rare complication of chronic pancreatitis. This case highlights an exceedingly rare instance of bleeding pseudocyst causing hemosuccus pancreaticus without typical symptoms.
Area of Science:
- Gastroenterology and Hepatology
- Vascular Surgery
Background:
- Hemorrhage is a known complication of chronic pancreatitis.
- Pathogenesis includes splenic vein thrombosis, pancreatic lithiasis, and pseudocyst erosion into vessels.
Observation:
- Bleeding can manifest in the GI tract, peritoneal cavity, or retroperitoneum.
- Hemosuccus pancreaticus describes bleeding through the ampulla of Vater.
- This case presents an exceedingly rare cause of hemosuccus pancreaticus: a bleeding pseudocyst in the pancreatic head.
Findings:
- The patient experienced bleeding pseudocyst of the pancreatic head.
- This rare presentation occurred without gastrointestinal blood loss or abdominal pain.
- Hemosuccus pancreaticus was the result of the pseudocyst eroding into pancreatic vessels.
Implications:
- Highlights the diverse and rare presentations of bleeding in chronic pancreatitis.
- Emphasizes the importance of considering unusual etiologies for gastrointestinal bleeding.
- Suggests the need for advanced imaging and diagnostic approaches in complex cases.
Abstract:
Hemorrhage is an infrequent but known complication of chronic pancreatitis. The pathogenesis of spontaneous bleeding includes splenic vein thrombosis, pancreatic lithiasis, and erosion of a pseudocyst into vessels incorporated in its wall. Bleeding may occur into the gastrointestinal tract, the peritoneal cavity, or retroperitoneum. Moreover, bleeding can be severe, with rapid development of shock, or mild in patients who have exhibited minimal clinical symptoms. "Hemosuccus pancreaticus" is the term coined to describe the rare case of bleeding observed to occur through the ampulla of Vater. Exceedingly rare, as was the case in our patient, is when hemosuccus pancreaticus is due to a bleeding pseudocyst of the head of the pancreas in the absence of gastrointestinal blood loss as well as abdominal pain.