%0 Journal Article
%T Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre
%A Ashwin Rammohan
%A Ravichandran Palaniappan
%A Sukumar Ramaswami
%A Senthil Kumar Perumal
%A Anand Lakshmanan
%A U. P. Srinivasan
%A Ravi Ramasamy
%A Jeswanth Sathyanesan
%J ISRN Radiology
%D 2013
%R 10.5402/2013/191794
%X Background. Hemosuccus pancreaticus (HP) is a very rare and obscure cause of upper gastrointestinal bleeding. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Methods. We retrospectively reviewed the records of all patients who presented with HP over the last 15 years at our institution between January 1997 and December 2011. Results. There were a total of 51 patients with a mean age of 32 years. Nineteen patients had chronic alcoholic pancreatitis; twenty-six, five, and one patient had tropical pancreatitis, acute pancreatitis, and idiopathic pancreatitis, respectively. Six patients were managed conservatively. Selective arterial embolization was attempted in 40 of 45 (89%) patients and was successful in 29 of the 40 (72.5%). 16 of 51 (31.4%) patients required surgery. Overall mortality was 7.8%. Length of followup ranged from 6 months to 15 years. Conclusions. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition. 1. Introduction Hemosuccus pancreaticus (HP) is a rare and potentially life threatening clinical entity and is described as bleeding from the ampulla of Vater via the pancreatic duct. It is the least frequent cause of upper gastrointestinal bleeding (1/1500) and is most often caused by chronic pancreatitis, pancreatic pseudocysts, or pancreatic tumors [1¨C3]. HP is often difficult to diagnose, partly because of its rarity and due to its anatomical location and also because the bleeding is often intermittent and cannot be easily diagnosed by esophagogastroduodenoscopy (OGDscopy) in the intermittent phase [1, 4]. The diagnosis is not always easy to establish and often a long period elapses between the onset of the first symptoms and the precise location of the source of bleeding [2, 4]. The objective of our study was to highlight the challenges involved in the diagnosis and management of HP and
%U http://www.hindawi.com/journals/isrn.radiology/2013/191794/