SHM Converge Scientific Abstract ePoster Gallery-Pancreatic Puzzles: Hemosuccus Pancreaticus From a Bleeding Pancreatic Head Pseudoaneurysm

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This case describes a 58-year-old man with alcohol use disorder, recurrent chronic pancreatitis, and a known pancreatic head pseudocyst who presented with abdominal pain and melena. CT imaging showed contrast extravasation into the duodenal lumen, and a GI bleed protocol CT confirmed active bleeding. Upper endoscopy and push enteroscopy found scant blood near the major papilla, raising concern for hemosuccus pancreaticus.<br /><br />Interventional radiology performed mesenteric angiography, which identified a pseudoaneurysm of the third branch of the pancreaticoduodenal artery with active contrast extravasation. The patient underwent successful coil embolization without immediate complications. He had some residual melena afterward, but repeat nuclear medicine and CT GI bleed studies showed no ongoing bleeding. His melena eventually resolved, and he was discharged home.<br /><br />The report emphasizes that pseudoaneurysms are rare but dangerous vascular complications of pancreatitis, with mortality rates reported between 15% and 50% if bleeding occurs. Hemosuccus pancreaticus is a particularly rare and potentially fatal form of bleeding into the gastrointestinal tract through the pancreatic duct. Diagnosis and treatment are usually achieved with mesenteric angiography and embolization, while surgery may be required if bleeding persists, though surgical options carry high risk.<br /><br />The key lesson is the importance of early recognition of pancreatitis-related vascular complications. Prompt imaging, angiography, and endovascular treatment can prevent major morbidity and mortality, as demonstrated in this successful case.

Asset Subtitle

Ethan F. Keller

Meta Tag

Author List Abhishek Agnihotri, Ethan F. Keller, Francis Lim, Gil Hoang, Taimur Bayar-Masood

Category Clinical Vignettes

Concept Hemosuccus Pancreaticus

Concept Pancreatic Pseudoaneurysm

Concept Endovascular Coil Embolization

Concept Retinal Hemorrhage

Concept Pancreaticoduodenal Artery Pseudoaneurysm

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Ethan F. Keller

Track Adult

Keywords

pancreatitis

pseudoaneurysm

hemosuccus pancreaticus

coil embolization

mesenteric angiography

gastrointestinal bleeding

duodenal bleeding

pancreaticoduodenal artery

melena

pancreatic pseudocyst

Hemosuccus Pancreaticus

Pancreatic Pseudoaneurysm

Endovascular Coil Embolization

Retinal Hemorrhage

Pancreaticoduodenal Artery Pseudoaneurysm