An Unusual Cause of Upper Gastrointestinal Bleed: A Case Report and Brief Review of Literature | Chapter 13 | Emerging Research in Medical Sciences Vol. 2
A case of a 48-year-old female, who
presented with refractory haemetemesis. Her oesophago-gastroduodenoscopy showed
only a healing ulcer but profuse bleeding was seen from duodenum. In spite of a
negativeoesophago-gastroduodenoscopy she was bleeding profusely with
hemodynamic decompensation. Doppler coeliac trunk showed a supra pancreaticcystic
lesion with yin-yang pattern of blood flow confirming a pseudo aneurysm
involving the superior and inferior pancreatioduodenal arterial arcade using
digital subtraction angiography. The conversion of a pancreatic pseudo cyst
into a pseudo aneurysm is potential lethal complication because, when rupture
occurs, mortality rises up to 40%. She was diagnosed to have pancreatic
pseudocyst, psedoaneurysm and haemosuccus pancreaticus with wirsungorrhagia and
was offered arterial embolization following which she improved. Patients with
chronic calcificpancratitis (CCP) could remain silent and can present with
normal amylase and lipase. Complications such as pseudo cysts orpseudoaneurysms
can be asymptomatic. The pancreas should be considered a possible site of
hemorrhage in CCP in cases of refractory upper gasrtrointestinal haemorrhage.
We highlight the importance of looking for causes other than bleeding
duodenal/gastric ulcer/oesophageal varices in case of a refractoryhametemeis
giving the patient option of a nonsurgical modality of treatment and it’s
reducedrisks. The effectiveness of embolisation for bleeding psuedoaneurysms is
emphasized.
Author(s) Details
C. Rajasekharan
Government Medical College
Hospital, Trivandrum, India.
D. S. Anand Raja
Government Medical College
Hospital, Trivandrum, India.
M. P. Archana
Government Medical College
Hospital, Trivandrum, India.
R. Parvathy
Regional Cancer Centre,
Trivandrum, India.
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