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Hemosuccus pancreaticus, also known as pseudohematobilia or Wirsungorrhage is a rare cause of hemorrhage in the gastrointestinal tract. It is caused by a. Methods: We reviewed our experience with management of 17 patients admitted to surgery or gastroenterology units for hemosuccus pancreaticus between. Hemosuccus pancreaticus (HP) is a rare and potentially life threatening clinical entity and is described as bleeding from the ampulla of Vater.

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Embolization and surgery are both equally effective and complementary. An unnamed vessel in the pseudocyst wall was the cause of bleed in nine patients. Procedures included distal pancreatectomy and splenectomy in nine cases, central pancreatectomy in one case, intracystic ligation of the blood vessel in five cases, and aneurysmal ligation and bypass graft in one case Table 6 and Figure 2.

On pre-contrast CT scan, the characteristic finding of clotted blood in the pancreatic duct, known as the sentinel clot, is seldom seen; however, it attests the bleeding from the pancreas. Haemorrhage into the pancreatic duct Hemosuccus pancreaticus: Due to its rare occurrence and the insufficient knowledge available which is limited to several case reports and a few case series [ 48 ], diagnosis is often delayed or missed.

Hematemesis is less frequent, and the rupture into the abdominal cavity or the retroperitoneum is rare [ [15][16][17] ]. The patient did not hrmosuccus further episodes of bleeding or abdominal pain. Pancreatic Retention Cyst Secondary to Pancreatitis. Case report We report two cases of hemosuccus pancreaticus managed pancreatiucs our institution in the past three years. An arterial abnormality was found to be at cause in five patients The first step is assessment of the severity of the blood loss, resuscitation and appropriate monitoring.


Hemosuccus pancreaticus: A mini-review

There was evidence of splenic vein rupturing into the pancreatic duct. CECT abdomen coronal showing a large pseudocyst with extravasation of contrast within it black arrow Case 2.

Angiographic study could not localize the site of bleeding. In some rare cases, active bleeding can be seen from the duodenal ampulla [ 263334 ]. HP is even treated as a complication of chronic pancreatitis [ 18 ]. Hmosuccus page was last edited on 15 Mayat One patient had histologically proven pancreatifus cirrhosis Child-Pugh A5. Hepatobiliary Pancreat Dis Int. After removal of the clots and slight pressure on the blister-like area, arterial bleeding was seen which was controlled with polypropylene sutures.

The former is termed Wirsungorrhage and the latter is termed Santorinirrhage. The various diagnostic modalities that pahcreaticus aid in the diagnosis of hemosuccus pancreaticus include contrast-enhanced CT, esophagogastroduodenoscopy, selective angiography and sometimes EUS and endoscopic retrograde cholangio pancreatography ERCP.

Pancrsaticus pancreaticus is an entity diagnosed based on clinical, endoscopic and radiological findings, and a definitive diagnosis can be established only with angiography. A Histopathologica examination showing evidence of chronic calcifying pancreatitis and B splenic congestion. Although most cases can be managed by angioembolization, surgery plays an important role.


Considering the influence of pancreatic enzymes, drug therapy seems feeble. Hemosuccus pancreaticus after penetrating trauma to the abdomen. Unfortunately, the patient hemorrhaged that night.

During the surgical procedure, it is sometimes difficult to confirm the source of bleeding and to determine the resecting line of the pancreas. Pancrezticus was repeated after an episode of melena which showed blood spurting from the ampulla.

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Pseudoaneurysm hemorrhage as a complication of pancreatitis. Surgical treatment is indicated when there is uncontrolled bleeding, persistent shock, failure of embolization, rebleeding after embolization, or when initial angiography shows no abnormal findings.

Hemosuccus Pancreaticus: A Mysterious Cause of Gastrointestinal Bleeding

In the event of continued destabilization or failed angioembolization, the patient was taken up for emergency surgery. Ischemia can develop in the tissue supplied by the artery if the collateral circulation is insufficient, if the thrombosis is too extensive or if the embolization material migrates. Gastrointestinal hemorrhage through the pancreatic duct. The causes of hemosuccus pancreaticus can be grouped into diseases of the pancreas and diseases of the vascular structures around the pancreas.