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Diagnostic conundrum: an elusive bleeding source in patient with recurrent gastrointestinal bleeding
  1. Laura Shannon1,
  2. David Campbell2,
  3. Tony C K Tham1 and
  4. Grant R Caddy1
  1. 1Gastroenterology, Ulster Hospital, Dundonald, UK
  2. 2Radiology, Ulster Hospital, Dundonald, UK
  1. Correspondence to Dr Laura Shannon; lmshannon{at}


Over a 6-month period, a 69-year-old woman presented with recurrent symptomatic anaemia, melaena and haematochezia. Extensive investigations were carried out, including CT of the abdomen and pelvis, oesophagogastroduodenoscopy, colonoscopy, two capsule endoscopies and two CT angiograms. The lack of active bleeding at the time of both CT angiograms meant a diagnosis was only made following retrospective examination of images by interventional radiology once fresh ampullary bleeding was identified on capsule endoscopy. The unifying diagnosis was haemosuccus pancreaticus given the combination of the left gastric artery pseudoaneurysm, fresh bleeding identified from ampulla and the patient’s history of chronic alcohol-related pancreatitis. Subsequent coil embolisation was performed to an optimal result with no recurrence of symptoms to date.

  • pancreas and biliary tract
  • endoscopy
  • GI bleeding
  • interventional radiology

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  • Contributors All authors agree to the publication and agree that the work has not been published elsewhere. DC performed coil embolisation and provided the diagnostic and therapeutic interventional images. TCKT and GRC performed endoscopies and provided the relevant images. LS was the main contributor in writing this case report under the supervision of GRC. All authors read and approved the final revised report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TCKT reports personal fees from Galapagos, personal fees from Biogen, personal fees from Janssen, outside the submitted work.

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