Hemosuccus pancreaticus complicating chronic pancreatitis: An obscure cause of upper gastrointestinal bleeding

George H. Sakorafas, Michael G. Sarr, David R. Farley, Florencia Que, James C. Andrews, Michael B. Farnell

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: Hemosuccus pancreaticus, a rare form of upper gastrointestinal bleeding, may complicate chronic pancreatitis and pose a significant diagnostic and therapeutic dilemma. Aim: To present our experience with this potentially life-threatening complication of chronic pancreatitis. Methods: We reviewed our experience with management (both operative as well as angiographic embolization) of patients with hemosuccus pancreaticus complicating histologically documented chronic pancreatitis between 1976 and 1997. Diagnosis of hemosuccus pancreaticus was based on clinical presentation, preoperative endoscopic and radiographic imaging, operative findings, and pathologic evaluation. Results: During the period, we managed eight patients with hemosuccus pancreaticus (1.5% of all patients with chronic pancreatitis treated surgically). Gastrointestinal bleeding presented as hematemesis in three and hematochezia in three, but all had recent melena and were anemic; three of these patients were hemodynamically unstable. Abdominal pain was present in six. When performed, angiography (n=6) was diagnostic of a pseudoaneurysm; computed tomography (n=7) showed a pseudoaneurysm in two and a pseudocyst in five. Endoscopy (n=8) revealed blood issuing from the ampullary papilla in two patients. Operative management (n=6) involved distal pancreatectomy, pancreatoduodenectomy, or total pancreatectomy in two patients each. Angiographic embolization was successful in one patient, but the other died from uncontrollable hemorrhage. Conclusions: Hemosuccus pancreaticus is rare, but should be considered in patients with chronic pancreatitis and gastrointestinal bleeding. In the absence of pancreatitis-related indications for surgery, angiographic embolization can be definitive treatment. If there are pancreatitis-related indications for operation, angiographic embolization tray allow an elective operative procedure based on structural changes of the pancreas. If embolization fails, pancreatic resection is usually required, often on an emergent basis.

Original languageEnglish (US)
Pages (from-to)124-128
Number of pages5
JournalLangenbeck's Archives of Surgery
Volume385
Issue number2
StatePublished - Mar 2000

Fingerprint

Chronic Pancreatitis
Hemorrhage
Pancreatectomy
False Aneurysm
Pancreatitis
Melena
Hematemesis
Pancreaticoduodenectomy
Gastrointestinal Hemorrhage
Operative Surgical Procedures
Abdominal Pain
Endoscopy
Pancreas
Angiography
Tomography
Therapeutics

Keywords

  • Hemoductal pancreatitis
  • Hemosuccus pancreaticus
  • Pancreatic duct hemorrhage
  • Upper gastrointestinal bleeding
  • Wirsungorrhage

ASJC Scopus subject areas

  • Surgery

Cite this

Sakorafas, G. H., Sarr, M. G., Farley, D. R., Que, F., Andrews, J. C., & Farnell, M. B. (2000). Hemosuccus pancreaticus complicating chronic pancreatitis: An obscure cause of upper gastrointestinal bleeding. Langenbeck's Archives of Surgery, 385(2), 124-128.

Hemosuccus pancreaticus complicating chronic pancreatitis : An obscure cause of upper gastrointestinal bleeding. / Sakorafas, George H.; Sarr, Michael G.; Farley, David R.; Que, Florencia; Andrews, James C.; Farnell, Michael B.

In: Langenbeck's Archives of Surgery, Vol. 385, No. 2, 03.2000, p. 124-128.

Research output: Contribution to journalArticle

Sakorafas, GH, Sarr, MG, Farley, DR, Que, F, Andrews, JC & Farnell, MB 2000, 'Hemosuccus pancreaticus complicating chronic pancreatitis: An obscure cause of upper gastrointestinal bleeding', Langenbeck's Archives of Surgery, vol. 385, no. 2, pp. 124-128.
Sakorafas, George H. ; Sarr, Michael G. ; Farley, David R. ; Que, Florencia ; Andrews, James C. ; Farnell, Michael B. / Hemosuccus pancreaticus complicating chronic pancreatitis : An obscure cause of upper gastrointestinal bleeding. In: Langenbeck's Archives of Surgery. 2000 ; Vol. 385, No. 2. pp. 124-128.
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abstract = "Background: Hemosuccus pancreaticus, a rare form of upper gastrointestinal bleeding, may complicate chronic pancreatitis and pose a significant diagnostic and therapeutic dilemma. Aim: To present our experience with this potentially life-threatening complication of chronic pancreatitis. Methods: We reviewed our experience with management (both operative as well as angiographic embolization) of patients with hemosuccus pancreaticus complicating histologically documented chronic pancreatitis between 1976 and 1997. Diagnosis of hemosuccus pancreaticus was based on clinical presentation, preoperative endoscopic and radiographic imaging, operative findings, and pathologic evaluation. Results: During the period, we managed eight patients with hemosuccus pancreaticus (1.5{\%} of all patients with chronic pancreatitis treated surgically). Gastrointestinal bleeding presented as hematemesis in three and hematochezia in three, but all had recent melena and were anemic; three of these patients were hemodynamically unstable. Abdominal pain was present in six. When performed, angiography (n=6) was diagnostic of a pseudoaneurysm; computed tomography (n=7) showed a pseudoaneurysm in two and a pseudocyst in five. Endoscopy (n=8) revealed blood issuing from the ampullary papilla in two patients. Operative management (n=6) involved distal pancreatectomy, pancreatoduodenectomy, or total pancreatectomy in two patients each. Angiographic embolization was successful in one patient, but the other died from uncontrollable hemorrhage. Conclusions: Hemosuccus pancreaticus is rare, but should be considered in patients with chronic pancreatitis and gastrointestinal bleeding. In the absence of pancreatitis-related indications for surgery, angiographic embolization can be definitive treatment. If there are pancreatitis-related indications for operation, angiographic embolization tray allow an elective operative procedure based on structural changes of the pancreas. If embolization fails, pancreatic resection is usually required, often on an emergent basis.",
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AB - Background: Hemosuccus pancreaticus, a rare form of upper gastrointestinal bleeding, may complicate chronic pancreatitis and pose a significant diagnostic and therapeutic dilemma. Aim: To present our experience with this potentially life-threatening complication of chronic pancreatitis. Methods: We reviewed our experience with management (both operative as well as angiographic embolization) of patients with hemosuccus pancreaticus complicating histologically documented chronic pancreatitis between 1976 and 1997. Diagnosis of hemosuccus pancreaticus was based on clinical presentation, preoperative endoscopic and radiographic imaging, operative findings, and pathologic evaluation. Results: During the period, we managed eight patients with hemosuccus pancreaticus (1.5% of all patients with chronic pancreatitis treated surgically). Gastrointestinal bleeding presented as hematemesis in three and hematochezia in three, but all had recent melena and were anemic; three of these patients were hemodynamically unstable. Abdominal pain was present in six. When performed, angiography (n=6) was diagnostic of a pseudoaneurysm; computed tomography (n=7) showed a pseudoaneurysm in two and a pseudocyst in five. Endoscopy (n=8) revealed blood issuing from the ampullary papilla in two patients. Operative management (n=6) involved distal pancreatectomy, pancreatoduodenectomy, or total pancreatectomy in two patients each. Angiographic embolization was successful in one patient, but the other died from uncontrollable hemorrhage. Conclusions: Hemosuccus pancreaticus is rare, but should be considered in patients with chronic pancreatitis and gastrointestinal bleeding. In the absence of pancreatitis-related indications for surgery, angiographic embolization can be definitive treatment. If there are pancreatitis-related indications for operation, angiographic embolization tray allow an elective operative procedure based on structural changes of the pancreas. If embolization fails, pancreatic resection is usually required, often on an emergent basis.

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