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Rare disease
CASE REPORT
Embolisation of branches of the superior mesenteric artery in the treatment of haemosuccus pancreaticus
  1. Selma Regina de Oliveira Raymundo1,2,
  2. Gabriela Leopoldino da Silva3,
  3. Luiz Fernando Reis3 and
  4. Antonio Fernandes Freire3
  1. 1 cardiologia e cirugia vascular, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
  2. 2 Hospital de Base, São Paulo, Brazil
  3. 3 serviço de angiologia e cirurgia endovascular, Hospital de Base, São Paulo, Brazil
  1. Correspondence to Dra Selma Regina de Oliveira Raymundo, selma_ray{at}terra.com.br, selma.raymundo{at}gmail.com

Abstract

Haemosuccus pancreaticus (HP) is an uncommon cause of upper gastrointestinal (GI) bleeding, most often intermittent, making it difficult to diagnose, becoming fatal. It usually occurs in patients with chronic pancreatitis and is caused by the rupture of a visceral aneurysm within the main pancreatic duct. The association between pseudoaneurysm formation and pancreatitis is well established. Pseudoaneurysm occurs in 3.5%–10% of pancreatitis cases and its rupture is a rare but life-threatening complication of chronic pancreatitis occurring in 6%–8% of patients with pseudocysts and corresponds to less than 1% of cases of GI bleeding.

Its diagnosis is challenging, given the intermittent nature of bleeding. Angiographic therapy is considered the first-choice treatment, especially in patients who are stable haemodynamically. We present a case of embolisation of inferior pancreaticoduodenal branches with polyvinyl alcohol microparticles in the treatment of HP.

  • GI bleeding
  • pancreatitis

https://doi.org/10.1136/bcr-2018-229110

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    Footnotes

    • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data: SRdOR, GLdS, LFR, AFF. Drafing the work or revising it critically for important intellectual content: SRdOR, GLdS, LFR. Final approval of the version published: SRdOR, GLdS, LFR, AFF. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SRdOR, GLdS, LFR, AFF.

    • Funding The authors no have a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.