Type:
Educational Exhibit
Keywords:
Embolisation, Arthrography, CT-Angiography, Catheter arteriography, Pancreas, Interventional vascular, Abdomen, Haemorrhage
Authors:
H. Smith, B. Boles; QLD/AU
DOI:
10.26044/ranzcr2019/R-0074
Background
Haemosuccus pancreaticus is a rare cause of upper gastrointestinal haemorrhage characterised by bleeding through the duodenal ampulla via the pancreatic duct. It is estimated to be the underlying aetiology in only one out of every 1500 cases of upper gastrointestinal bleeding, with approximately 150 cases reported in the literature since Lower and Farell first described the disease in 1931. 1-3
The condition is most commonly seen in patients with acute or chronic pancreatitis. The most common mechanisms are due to haemorrhage into a pancreatic pseudocyst via erosion of pericystic arteries, or formation of a communicating pseudoaneurysm. 4-5 Other aetiologies include pancreaticolithiasis, pancreatic tumour, aneurysm or arteriovenous malformation rupture, iatrogenic via endoscopic procedures, trauma or rarely infection.1,5,6 The diagnosis is typically made when a clinical triad of abdominal pain, gastrointestinal bleeding and hyperlipasaemia is present with associated underlying inflammatory pancreatic disease. Although the blood loss is usually of a small volume and intermittent, haemosuccus pancreaticus has been associated with life threatening haemorrhage. 7