Upper Gastrointestinal Bleed: Do not Forget a Look at Ampulla

Hemosuccus pancreaticus (HP) and hemobilia (HB) are uncommon causes of upper gastrointestinal bleed. In this report, 4 cases of HP and 1 case of HB with intermittent bleeding are described. The causes of HP are rupture of splenic artery pseudoaneurysm in 3 and gastroduodenal artery aneurysm in one. The cause of HB is due to cystic artery bleed. HP can be secondary to chronic or acute pancreatitis with bleeding from pseudoaneurysm arising from peripancreatic arteries. Iatrogenic transhepatic techniques, trauma, operative injuries, malignancy, and inflammation in hepatobiliary system are the common causes of HB. All the cases are missed on first endoscopy and diagnosed on second‑look endoscopy. A strong clinical suspicion is required at first endoscopy for early diagnosis and management. This case report compares presentation of HP with HB, diagnosis, and their management.

Keywords

Hemobilia - hemosuccus pancreaticus - pseudoaneurysm

• References

• 1 Sandblom P. Gastrointestinal hemorrhage through the pancreatic duct. Ann Surg 1970; 171: 61-6
• 2 Pattarapuntakul T. Hemobilia: Diagnosis and management. Songklanagarind Med J 2017; 35: 177-186
• 3 Baillie J. Hemobilia. Gastroenterol Hepatol 2012; 8: 270-2
• 4 Anil Kothari R, Leelakrishnan V, Krishnan M. Hemosuccus pancreaticus: A rare cause of gastrointestinal bleeding. Ann Gastroenterol 2013; 26: 175-7
• 5 Zaydfudim VM, Angle JF, Adams RB. Current management of hemobilia. Curr Surg Rep 2014; 2: 54
• 6 Mandaliya R, Krevsky B, Sankineni A, Walp K, Chen O. Hemosuccus pancreaticus: A mysterious cause of gastrointestinal bleeding. Gastroenterology Res 2014; 7: 32-7
• 7 Fazel I, Asle Soleimani H, Fallah S, Babaei M, Sedighi N, Marashi A. et al Hemosuccus pancreaticus in a patient with celiac trunk aneurysm. Arch Iran Med 2008; 11: 658-61
• 8 Gachabayov M, Kubachev K, Mityushin S, Zarkua N. Recurrent hemobilia due to right hepatic artery pseudoaneurysm. Clin Med Res 2017; 15: 96-9
• 9 Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysms and pseudoaneurysms: Clinical distinctions and CT appearances. AJR Am J Roentgenol 2007; 188: 992-9
• 10 Golzarian J, Nicaise N, Devière J, Ghysels M, Wery D, Dussaussois L. et al Transcatheter embolization of pseudoaneurysms complicating pancreatitis. Cardiovasc Intervent Radiol 1997; 20: 435-40