caa a22 4500 475791169 CHVBK 20180406123711.0 cr unu---uuuuu 170329e20000301xx s 000 0 eng 10.1007/s004230050254 doi (NATIONALLICENCE)springer-10.1007/s004230050254 Hemosuccus pancreaticus complicating chronic pancreatitis: an obscure cause of upper gastrointestinal bleeding [Elektronische Daten] [G. H. Sakorafas, M. G. Sarr, D. R. Farley, F. G. Que, J. C. Andrews, M. B. Farnell] Abstract : Background: Hemosuccus pancreaticus, a rare form of upper gastrointestinal bleeding, may complicate chronic pancreatitis and pose a significant diagnostic and therapeutic dilemma. Aim: To present our experience with this potentially life-threatening complication of chronic pancreatitis. Methods: We reviewed our experience with management (both operative as well as angiographic embolization) of patients with hemosuccus pancreaticus complicating histologically documented chronic pancreatitis between 1976 and 1997. Diagnosis of hemosuccus pancreaticus was based on clinical presentation, preoperative endoscopic and radiographic imaging, operative findings, and pathologic evaluation. Results: During the period, we managed eight patients with hemosuccus pancreaticus (1.5% of all patients with chronic pancreatitis treated surgically). Gastrointestinal bleeding presented as hematemesis in three and hematochezia in three, but all had recent melena and were anemic; three of these patients were hemodynamically unstable. Abdominal pain was present in six. When performed, angiography (n=6) was diagnostic of a pseudoaneurysm; computed tomography (n=7) showed a pseudoaneurysm in two and a pseudocyst in five. Endoscopy (n=8) revealed blood issuing from the ampullary papilla in two patients. Operative management (n=6) involved distal pancreatectomy, pancreatoduodenectomy, or total pancreatectomy in two patients each. Angiographic embolization was successful in one patient, but the other died from uncontrollable hemorrhage. Conclusions: Hemosuccus pancreaticus is rare, but should be considered in patients with chronic pancreatitis and gastrointestinal bleeding. In the absence of pancreatitis-related indications for surgery, angiographic embolization can be definitive treatment. If there are pancreatitis-related indications for operation, angiographic embolization may allow an elective operative procedure based on structural changes of the pancreas. If embolization fails, pancreatic resection is usually required, often on an emergent basis. Springer-Verlag Berlin Heidelberg, 2000 Key words Hemosuccus pancreaticus nationallicence Hemoductal pancreatitis nationallicence Wirsungorrhage nationallicence Pancreatic duct hemorrhage nationallicence Upper gastrointestinal bleeding nationallicence Sakorafas G. H. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut Sarr M. G. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut Farley D. R. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut Que F. G. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut Andrews J. C. Department of Radiology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA, US aut Farnell M. B. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut https://doi.org/10.1007/s004230050254 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004230050254 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sakorafas G. H. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut NATIONALLICENCE 700 1- Sarr M. G. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut NATIONALLICENCE 700 1- Farley D. R. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut NATIONALLICENCE 700 1- Que F. G. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut NATIONALLICENCE 700 1- Andrews J. C. Department of Radiology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA, US aut NATIONALLICENCE 700 1- Farnell M. B. Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA e-mail: mfarnell@mayo.edu, US aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer