Case Reports in Gastroenterology
Published: August 2011
Hemosuccus Pancreaticus following a Puestow Procedure in a Patient with Chronic PancreatitisOkamoto H.a, b · Miura K.a · Fujii H.aaDepartment of Gastrointestinal, Breast and Endocrine Surgery, Faculty of Medicine, University of Yamanashi, Chuo, and bDepartment of Surgery, Tsuru Municipal Hospital, Tsuru, Japan
Hirotaka Okamoto Department of Surgery, Tsuru Municipal Hospital 5-1-55 Tsuru, Tsuru City, Yamanashi 402-0056 (Japan) Tel. +81 554 451 811, E-Mail hirotaka@yamanashi.ac.jp |
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Abstract
Hemosuccus pancreaticus is an unusual cause of gastrointestinal bleeding that occurs as a complication of chronic or acute pancreatitis. We report a case of extremely acute-onset hemosuccus pancreaticus occurring in a patient with chronic pancreatitis over a long-term follow-up after a Puestow procedure (side-to-side pancreaticojejunostomy). The patient was admitted to our hospital due to severe anemia and tarry stools indicative of gastrointestinal bleeding. Emergent endoscopy, including gastrointestinal fiberscopy and colon fiberscopy, showed no abnormal findings. Abdominal contrast-enhanced computed tomography and hemorrhagic scintigraphy did not detect a hemorrhagic lesion. Although interventional radiology was considered for diagnosis and treatment, conservative therapy seemed sufficient to affect hemostasis. Two weeks later, however, acute intestinal bleeding with hemodynamic shock occurred, and exploration was performed without delay. Intraoperative endoscopy through an incision of the reconstructed jejunal loop in the close proximal end revealed a site of active bleeding from the side-to-side anastomotic pancreatic duct. Following a longitudinal incision of the jejunal loop, a bleeding point was sutured and ligated on direct inspection. The patient showed a good postoperative course.
© 2011 S. Karger AG, Basel
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Article / Publication Details
Published online: August 18, 2011
Issue release date: May – August
Number of Print Pages: 5
Number of Figures: 2
Number of Tables: 0
eISSN: 1662-0631 (Online)
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