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The wirsungorrhagies: causes and management in 14 patients
F Dinu1, J Devière, A Van Gossum
1Dept. of Gastroenterology and Hepatopancreatology, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Background And Study Aims:
Wirsungorrhagy is an extremely rare cause of upper gastrointestinal bleeding. The present study describes 14 cases observed over a seven-year period.
Material And Methods:
Among 10,000 endoscopic retrograde cholangiopancreatographies performed between 1989 and 1996 we have identified 14 wirsungorrhagies, which were reviewed retrospectively. They occurred in patients with chronic and acute pancreatitis, and primary and metastatic pancreatic cancer.
Results:
Clinical signs of bleeding were present in six patients; three other patients had occult blood loss, and in five patients wirsungorrhagy was caused by endoscopic manipulation (n=3) or extracorporeal shock-wave lithotripsy (n=2) without clinical or hemodynamic effects. In six patients, wirsungorrhagy was managed by endoscopic methods. Five patients in unstable clinical conditions had an arteriography which allowed identification and treatment of the source of bleeding in three cases. Two patients with bleeding from a communicating cyst in chronic pancreatitis underwent surgery.
Conclusions:
Wirsungorrhagy can be responsible for massive bleeding in certain patients, especially those with chronic pancreatitis and pseudoaneurysm. In these cases, arteriography is most useful for identification and treatment of the bleeding. When it occurs during endoscopic manipulations, it can usually be managed endoscopically and/or stops spontaneously with appropriate main pancreatic duct drainage. When it occurs in patients with pancreatic tumors, optimal treatment is surgical resection; this is, unfortunately, usually not feasible.
Insights
Wirsungorrhagy, a rare cause of upper GI bleeding, can lead to massive hemorrhage, particularly in chronic pancreatitis. Arteriography is key for diagnosis and treatment, while endoscopic methods suffice for iatrogenic cases.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Pancreatic Diseases
Background:
- Wirsungorrhagy, bleeding into the main pancreatic duct, is an exceptionally rare cause of upper gastrointestinal bleeding.
- This study retrospectively reviews 14 cases of wirsungorrhagy identified over a seven-year period from 10,000 endoscopic retrograde cholangiopancreatographies.
Observation:
- Cases occurred in patients with chronic pancreatitis, acute pancreatitis, and pancreatic cancer (primary and metastatic).
- Bleeding manifestations ranged from overt clinical signs (6 patients) to occult blood loss (3 patients) and asymptomatic cases post-endoscopic procedures (5 patients).
Findings:
- Endoscopic management was successful in 6 patients.
- Arteriography identified and treated bleeding sources in 3 of 5 patients with unstable conditions.
- Surgical intervention was performed in 2 patients with bleeding pseudoaneurysms associated with chronic pancreatitis.
Implications:
- Wirsungorrhagy can cause significant bleeding, especially in chronic pancreatitis with pseudoaneurysms, where arteriography is crucial for diagnosis and treatment.
- Iatrogenic wirsungorrhagy often resolves with endoscopic intervention and pancreatic duct drainage.
- Surgical resection is the optimal treatment for wirsungorrhagy in pancreatic tumors, though often not feasible.