Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 236-244
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.236
Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis: A case report and review of literature
Hai-Yu Cui, Cheng-Hang Jiang, Jie Dong, Yang Wen, You-Wei Chen
Hai-Yu Cui, Jie Dong, You-Wei Chen, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Cheng-Hang Jiang, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Yang Wen, Department of Radiology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Author contributions: Cui HY was responsible for collecting the medical history of the patient and drafting the paper; Jiang CH was responsible for collecting the medical history of the patient; Dong J was responsible for drafting the paper; Wen Y is a radiologist who provided the radiological results; Chen YW reviewed the literature and revised the manuscript; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Wei Chen, MSc, Chief Doctor, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou 310014, Zhejiang Province, China. cyw@zju.edu.cn
Received: September 20, 2020
Peer-review started: September 20, 2020
First decision: October 17, 2020
Revised: October 30, 2020
Accepted: November 9, 2020
Article in press: November 9, 2020
Published online: January 6, 2021
Processing time: 99 Days and 23.8 Hours
Abstract
BACKGROUND

Hemosuccus pancreaticus is a very rare but severe form of upper gastrointestinal hemorrhage. The most common etiology is peripancreatic pseudoaneurysm secondary to chronic pancreatitis. Due to the rarity of gastroduodenal artery pseudoaneurysms, most of the current literature consists of case reports. Limited knowledge about the disease causes diagnostic difficulty.

CASE SUMMARY

A 39-year-old man with a previous history of chronic pancreatitis was hospitalized due to hematemesis and melena for 2 wk, with a new episode lasting 1 d. Two weeks prior, the patient had visited a local hospital for repeated hematemesis and melena. Esophagogastroduodenoscopy indicated hemorrhage in the descending duodenum. The patient was discharged after the bleeding stopped, but hematemesis and hematochezia recurred. Bedside esophago-gastroduodenoscopy showed no obvious bleeding lesion. On admission to our hospital, he had hematemesis, hematochezia, left middle and upper abdominal pain, severe anemia, and elevated blood amylase. After admission, intermittent hematochezia was observed. Abdominal contrast-enhanced computed tomography revealed a pseudoaneurysm in the pancreas head. Angiography confirmed the diagnosis of gastroduodenal artery pseudoaneurysm. The pseudoaneurysm was successfully embolized with a coil and cyanoacrylate. No bleeding was observed after the operation. After discharge from the hospital, a telephone follow-up showed no further bleeding signs.

CONCLUSION

Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis is very rare. This diagnosis should be considered when upper gastrointestinal bleeding and abdominal pain are intermittent. Abdominal enhanced computed tomography and angiography are important for diagnosis and treatment.

Keywords: Hemosuccus pancreaticus; Chronic pancreatitis; Gastroduodenal artery pseudoaneurysm; Upper gastrointestinal bleeding; Angiographic embolization; Case report

Core Tip: Hemosuccus pancreaticus (HP) caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis is a very rare but severe form of upper gastrointestinal hemorrhage. Limited knowledge about the disease causes diagnostic difficulty. Here, we present a case of HP caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis, which was diagnosed by abdominal enhanced computed tomography and angiography and treated with transarterial embolization. The diagnosis of HP should be considered when upper gastrointestinal bleeding and abdominal pain are intermittent. Abdominal enhanced computed tomography and angiography are important for diagnosis and treatment.