Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding

AIM: The purpose of this study was to analyze the diagnostic and therapeutic features of hemosuccus pancreaticus. METHODS: We conducted a retrospective study of nine patients (eight men and one woman, mean age 60 yrs) admitted to surgery or gastroenterology units for hemossucus pancreaticus between 1981 and 2003. The following were studied: symptoms, contribution of established morphologic exams (upper digestive endoscopy, computed tomography (CT) and selective digestive angiography) and treatment. RESULTS: Hemosuccus pancreaticus occurred in chronic alcoholic pancreatitis (N=8) and chronic familial pancreatitis (N=1). Seven patients (77.8%) presented overt digestive bleeding (one melena, two hematochezia, two melena with hematochezia, one hematemesis, one hemorrhagic shock). The inaugural sign was anemia in one patient and epigastric pain in another. An upper digestive endoscopy, performed in eight patients (88.9%), revealed fresh red blood in the first or second duodenum in three and hemossucus pancreaticus in three others. Arteriography was performed in eight patients (88.9%) and CT angiography in one. Surgery was performed in 5 patients (55.6%), after embolization in one. Embolization was effective in 3 patients. Therapeutic abstention proved successful in one patient. There were no deaths. CONCLUSIONS: Hemosuccus pancreaticus is a rare cause of digestive bleeding. Upper digestive endoscopy and selective digestive angiography during active bleeding can provide the diagnosis. Endovascular treatment can control an unstable hemodynamic situation before elective surgery to prevent recurrence, which can be more severe than the first event.     

Haemosuccus pancreaticus, a rare cause of upper gastrointestinal bleeding

Upper gastrointestinal bleeding is most commonly caused by lesions in the oesophagus, stomach or duodenum. In a minority of cases the bleeding originates from the pancreatic duct, and is known as haemosuccus pancreaticus. In many cases it is associated with chronic pancreatitis. Diagnostic strategies and therapeutic options are discussed.     

Gastric teratoma: a rare cause of gastrointestinal bleeding.

Gastric teratoma is a rare tumor of infancy, almost exclusively found in males. We report a 6-month-old male child with gastric teratoma who presented with gastrointestinal bleeding; he was treated successfully with local excision of the tumor.     

A typical presentation of a rare cause of obscure gastrointestinal bleeding

A 52-year-old white woman had suffered from intermittent gastrointestinal (GI) bleeding for one year. Upper GI endoscopy, colonoscopy and peroral doubleballoon enteroscopy (DBE) did not detect any bleeding sour ce, suggesting obscure GI bleeding. However, in video capsule endoscopy a jejunal ulceration without blee ding signs was suspected and this was endoscopically conf irmed by another peroral DBE. After transfusion of packed red blood cells, the patient was discharged from our hospital in good general condition.Two weeks later she was readmitted because of another episode of acute bleeding. Multi-detector row computed tomography with 3D reconstruction was performed revealing a jejunal tumor causing lower gastrointestinal bleeding. The patient underwent exploratory laparotomy with partial jejunal resection and end-to-end jejunostomy for reconstruction. Histological examination of the specimen confirmed the diagnosis of a low risk gastrointestinal stromal tumor (GIST). Nine days after surgery the patient was discharged in good health. No signs of gastrointestinal rebleeding occurred in a followup of eight months. We herein describe the comp lex presentation and course of this patient with GIST and also review the current approach to treatm ent.     

Colonic varices: a rare, but important cause of gastrointestinal hemorrhage

The diagnosis of colonic varices, a rare cause of gastrointestinal hemorrhage, may be exceedingly difficult. If this entity is not considered, a rectal or colonic biopsy may lead to brisk and dangerous bleeding, as in our patient on two separate occasions. Once the diagnosis is made, appropriate surgery will prevent future bleeding episodes.