Massive pancreatic duct haemorrhage

Area of Science:

• Gastroenterology
• Vascular Surgery
• Diagnostic Imaging

Background:

• Direct fistulas between the splenic artery and pancreatic duct are uncommon vascular anomalies.
• Literature suggests these fistulas are predominantly associated with splenic artery aneurysms.
• Diagnostic challenges often lead to delayed or incorrect surgical interventions.

Observation:

• A case report details a patient with a direct splenic artery-pancreatic duct fistula.
• The fistula resulted in recurrent, life-threatening hemorrhage, ultimately leading to death.
• Crucially, this case lacked an angiographically evident splenic artery aneurysm, differentiating it from typical presentations.

Findings:

• The absence of a demonstrable aneurysm in this case complicates the established etiology of splenic artery-pancreatic duct fistulas.
• Diagnostic difficulties underscore the need for high clinical suspicion in patients with unexplained gastrointestinal bleeding and pancreatic symptoms.
• The fatal outcome emphasizes the critical nature and potential severity of this condition.

Implications:

• This case expands the known spectrum of splenic artery-pancreatic duct fistula etiology.
• It highlights the importance of considering non-aneurysmal causes and advanced imaging in diagnosis.
• Effective management strategies, including distal pancreatectomy and pancreatic artery embolization, require careful consideration based on individual patient factors.