Upper Gastrointestinal Bleeding Due to Splenic Artery Aneurysm Communicating to the Pancreatic Duct
A 56-year-old male patient presented as an emergency with upper gastrointestinal bleeding. The patient had a history of recurrent alcohol-induced pancreatitis. Active but spontaneously ceasing papillary bleeding was striking on gastroscopy. Computed tomography revealed the cause to be a splenic artery pseudoaneurysm due to autodigestion-induced arrosion bleeding into the pancreatic duct in the setting of chronic pancreatitis. In the case of patients with chronic pancreatitis and symptoms of gastrointestinal bleeding, bleeding from the pancreatic duct (Haemosuccus pancreaticus) needs to be considered in the differential diagnosis as a rare cause of bleeding. This usually involves intermittent and only rarely hemodynamically relevant bleeding from the major duodenal papilla. The diagnosis is made on the basis of endoscopy, contrast-enhanced computed tomography, and selective celiac artery angiography. Treatment measures include embolization or placement of an intraluminal vascular stent graft, as well as surgical intervention. Using celiac artery angiography, it was possible to successfully exclude the pseudoaneurysm (15 × 12 mm) in our patient with two Gianturco coils and the use of histoacryl.
Dott. Mag. Michele Sorleto, Lisa Schäfer, Klinik für Gastroenterologie, Hepatologie und Infektionskrankheiten,
Universitätsklinikum Minden, email@example.com, firstname.lastname@example.org
Dr. med. Michael Kuschnerow, Institut für Diagnostische Radiologie, Neuroradiologie und Nuklearmedizin Universitätsklinikum Minden
Conflict of interest statement: The authors state that there are no conflicts of interest.
Translated from the original German by Christine Rye.
Cite this as: Sorleto M, Schäfer L, Kuschnerow M: Upper gastrointestinal bleeding due to splenic artery aneurysm communicating
to the pancreatic duct. Dtsch Arztebl Int 2020; 117: 660. DOI: 10.3238/arztebl.2020.0660