P1558 - Alcohol-induced Gastrointestinal Bleeding: A Case of Hemosuccus Pancreaticus

Brian R. Goodman, DO, Dylan Flaherty, DO, Hadi Atassi, DO, Luis Marsano, MD
University of Louisville School of Medicine, Louisville, KY

Introduction: Hemosuccus pancreaticus (HP) occurs when there is bleeding from the pancreatic duct through the Ampulla of Vater into the small intestine. This syndrome is typically seen in patients 32-36 years old with a history of chronic pancreatitis, pancreatic tumors, or pancreatic pseudocysts. Patients present with abdominal pain, gastrointestinal (GI) bleeding, and high amylase levels. Here, a case is presented demonstrating HP secondary to a pseudoaneurysm in the gastroduodenal or pancreaticoduodenal arterial branches.

Case Description/Methods: A 39-year-old female with a history of May Thurner Syndrome, on anticoagulation, chronic pancreatitis, and alcohol use disorder with a chief complaint of hematemesis. On presentation, she endorsed abdominal pain and generalized weakness. She had a blood pressure of 83/60 and heart rate of 123 beats per minute. She had guarding and diffuse tenderness to palpation on physical exam. CT abdomen and pelvis was concerning for hemorrhagic pancreatitis. She had a hemoglobin of 10.7 g/dl and a platelet count of 91,000. Three days after admission, she developed melena and an acute hemoglobin drop to 7.4 g/dl. She had a CT angiogram which revealed a large pseudoaneurysm centered near the head and neck of the pancreas. Hyperdense clots and induration surrounded the pseudoaneurysm, suggesting active or chronic bleeding. Interventional radiology (IR) successfully performed urgent embolization of the area distal to the gastroduodenal pseudoaneurysm. She stabilized after IR embolization, with no further episodes of GI bleeding.

Discussion: This patient was diagnosed with HP via CT angiogram. The etiology was secondary to erosion of the pseudoaneurysm in the gastroduodenal or pancreaticoduodenal arteries located in the head and neck of the pancreas which led to bleeding into the pancreatic duct through the Ampulla of Vater. This is a rare cause of HP with approximately 6-17% incidence of intracystic bleeding in the setting of chronic pancreatitis. IR procedures such as coil embolization, stent graphing, and balloon tamponade are first line therapy with coil embolization being preferred with an overall 67% success rate. Due to coil embolization being performed with complete resolution of GI bleeding, her case is most consistent with HP. When diagnosing HP, it is imperative to stress urgency in treatment of these patients as bleeding is unlikely to stop without procedural or surgical intervention and heralds a 9.6% mortality rate.


Disclosures:
Brian Goodman indicated no relevant financial relationships.
Dylan Flaherty indicated no relevant financial relationships.
Hadi Atassi indicated no relevant financial relationships.
Luis Marsano indicated no relevant financial relationships.


Brian R. Goodman, DO, Dylan Flaherty, DO, Hadi Atassi, DO, Luis Marsano, MD. P1558 - Alcohol-induced Gastrointestinal Bleeding: A Case of Hemosuccus Pancreaticus, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.