Hemosuccus Pancreaticus

Lucky

Step 1: View clinicals

A 55 year old man complains of multiple episodes of melena and intermittent abdominal pain over the last 2 weeks. He is a heavy drinker, and was diagnosed with alcohol-related chronic pancreatitis 2 years ago. He is not on any medications currently. His medical, surgical and family histories are otherwise unremarkable. He does not smoke, and denies recreational drug use. A full blood count is significant for a hemoglobin of 8.5 g/dL and hematocrit of 26%.


Step 2: Order all relevant investigations

Upper GI Endoscopy

There are grade 1 esophageal varices, with no evidence of bleeding. No gastric or duodenal ulcers are present. Fresh blood is seen oozing from the ampulla of Vater.

Colonoscopy

colonoscopy reveals no abnormalities.

Endoscopic Ultrasound

The pancreas shows sonographic changes consistent with chronic pancreatitis. A heterogeneous inflammatory lesion is seen in the body of the pancreas.

CT + CTA Abdomen

There is evidence of chronic pancreatitis, along with a large thick-walled fluid collection near the body of the pancreas suggestive of a pancreatic pseudocyst. Angiography reveals active arterial extravasation from the pancreaticoduodenal arcade.


Step 3: Select appropriate management

Transfuse Blood stat
Exploratory Laparotomy
Coil Embolization
Pancreatic Resection


Score: ★★☆