Refractory hematemesis caused by haemoductal pancreatitis
We report a case of a 48-year-old female, who presented with refractory haemetemesis. Her oesophago-gastroduodenoscopy showed only a healing ulcer but profuse bleeding was seen from duodenum. In spite of a negative oesophago-gastroduodenoscopy she was bleeding profusely with haemodynamic decompensat...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2012-04-01
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| Series: | Gastroenterology Insights |
| Subjects: | |
| Online Access: | http://www.pagepress.org/journals/index.php/gi/article/view/3082 |
| _version_ | 1818019252224917504 |
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| author | Chandrasekharan Rajasekharan Velayudhan Ganga Thampi Jayapal |
| author_facet | Chandrasekharan Rajasekharan Velayudhan Ganga Thampi Jayapal |
| author_sort | Chandrasekharan Rajasekharan |
| collection | DOAJ |
| description | We report a case of a 48-year-old female, who presented with refractory haemetemesis. Her oesophago-gastroduodenoscopy showed only a healing ulcer but profuse bleeding was seen from duodenum. In spite of a negative oesophago-gastroduodenoscopy she was bleeding profusely with haemodynamic decompensation. Doppler coeliac trunk showed a suprapancreatic cystic lesion with yin-yang pattern of blood flow confirming a pseudo aneurysm involving the superior and inferior pancreatioduodenal arterial arcade using digital subtraction angiography. The conversion of a pancreatic pseudo cyst into a pseudo aneurysm is a potential lethal complication because, when rupture occurs, mortality rises up to 40%.She was diagnosed to have pancreatic pseudocyst, psedoaneurysm and haemosuccus pancreaticus with wirsungorrhagia and was offered arterial embolization following which she improved. Patients with chronic calcificpancratitis (CCP) could remain silent and can present with normal amylase and lipase. Complications such as pseudocysts or pseudoaneurysms can be asymptomatic. The pancreas should be considered a possible site of hemorrhage in CCP in cases of refractory upper gasrtrointestinal haemorrhage. We highlight the importance of looking for causes other than bleeding duodenal/gastic ulcer/oesophageal varices in case of a refractory hametemeis giving the patient option of a nonsurgical modality of treatment and it’s reduced risks.The effectiveness of embolistion for bleeding psuedoaneurysms is emphasized. |
| first_indexed | 2024-04-14T07:49:41Z |
| format | Article |
| id | doaj.art-7bfc1b34eaf646f5b53a8eeae8a2afa0 |
| institution | Directory Open Access Journal |
| issn | 2036-7414 2036-7422 |
| language | English |
| last_indexed | 2024-04-14T07:49:41Z |
| publishDate | 2012-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Gastroenterology Insights |
| spelling | doaj.art-7bfc1b34eaf646f5b53a8eeae8a2afa02022-12-22T02:05:14ZengMDPI AGGastroenterology Insights2036-74142036-74222012-04-0141e6e610.4081/gi.2012.e62102Refractory hematemesis caused by haemoductal pancreatitisChandrasekharan Rajasekharan0Velayudhan Ganga1Thampi Jayapal2Department of Internal Medicine, Medical College Hospital, Thiruvananthapuram, KeralaDepartment of Internal Medicine, Medical College Hospital, Thiruvananthapuram, KeralaDepartment of Internal Medicine, Medical College Hospital, Thiruvananthapuram, KeralaWe report a case of a 48-year-old female, who presented with refractory haemetemesis. Her oesophago-gastroduodenoscopy showed only a healing ulcer but profuse bleeding was seen from duodenum. In spite of a negative oesophago-gastroduodenoscopy she was bleeding profusely with haemodynamic decompensation. Doppler coeliac trunk showed a suprapancreatic cystic lesion with yin-yang pattern of blood flow confirming a pseudo aneurysm involving the superior and inferior pancreatioduodenal arterial arcade using digital subtraction angiography. The conversion of a pancreatic pseudo cyst into a pseudo aneurysm is a potential lethal complication because, when rupture occurs, mortality rises up to 40%.She was diagnosed to have pancreatic pseudocyst, psedoaneurysm and haemosuccus pancreaticus with wirsungorrhagia and was offered arterial embolization following which she improved. Patients with chronic calcificpancratitis (CCP) could remain silent and can present with normal amylase and lipase. Complications such as pseudocysts or pseudoaneurysms can be asymptomatic. The pancreas should be considered a possible site of hemorrhage in CCP in cases of refractory upper gasrtrointestinal haemorrhage. We highlight the importance of looking for causes other than bleeding duodenal/gastic ulcer/oesophageal varices in case of a refractory hametemeis giving the patient option of a nonsurgical modality of treatment and it’s reduced risks.The effectiveness of embolistion for bleeding psuedoaneurysms is emphasized.http://www.pagepress.org/journals/index.php/gi/article/view/3082pseudoaneurysm, embolization,digital subtraction angiography,Hemobilia, haemoductal pancreatitis. |
| spellingShingle | Chandrasekharan Rajasekharan Velayudhan Ganga Thampi Jayapal Refractory hematemesis caused by haemoductal pancreatitis Gastroenterology Insights pseudoaneurysm, embolization,digital subtraction angiography,Hemobilia, haemoductal pancreatitis. |
| title | Refractory hematemesis caused by haemoductal pancreatitis |
| title_full | Refractory hematemesis caused by haemoductal pancreatitis |
| title_fullStr | Refractory hematemesis caused by haemoductal pancreatitis |
| title_full_unstemmed | Refractory hematemesis caused by haemoductal pancreatitis |
| title_short | Refractory hematemesis caused by haemoductal pancreatitis |
| title_sort | refractory hematemesis caused by haemoductal pancreatitis |
| topic | pseudoaneurysm, embolization,digital subtraction angiography,Hemobilia, haemoductal pancreatitis. |
| url | http://www.pagepress.org/journals/index.php/gi/article/view/3082 |
| work_keys_str_mv | AT chandrasekharanrajasekharan refractoryhematemesiscausedbyhaemoductalpancreatitis AT velayudhanganga refractoryhematemesiscausedbyhaemoductalpancreatitis AT thampijayapal refractoryhematemesiscausedbyhaemoductalpancreatitis |