Abstract

Haemosuccus pancreaticus (HP) is a rare life threatening and difficult to diagnose cause of upper gastro-intestinal hemorrhage. It presents bleeding from the ampulla of Vater via the pancreatic duct. A 34-year-old woman was discharged from the Surgery Department after operation of pancreatic pseudocysts. Later she was rehospitalized twice due to bleeding from the contact drainage and melena. The upper GI endoscopy found gastric varices without bleeding and no pathologic changes of the papilla of Vater examined with a duodenoscope. Еndoscopic retrograde cholangiopancreatography (ERCP) revealed active bleeding from the papilla. Selective cannulation and contrast of the pancreatic duct found a distal stenosis, a cystic lesion at its level followed by a dilatation of the pancreatic duct in the body with defects in the lumen. Extravasation of the contrast from the duct to the body/tail pancreatic zone with contrasting of the left diaphragm cupola and the end of the contact drainage was observed. A pancreatic stent with side holes was placed to cover the lesion of the pancreatic duct in the tail. A distal stenosis of the choledochal duct was also detected due to possible compression by the pseudocyst in the pancreatic head and a stent was also placed. The control CT proved the correct position of the stents and reduced sizes of the pseudocyst. After ERCP was done a complete stop of the secretion from the retroperitoneal drainage was achieved. We reported a rare case of GI bleeding - HP, where ERCP could play a key role in its diagnosis and treatment.

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