Researchers describe a rare cause of hemosuccus pancreaticus in a patient with pancreatic cancer. The gastrointestinal bleeding was caused by erosion of pancreatic adenocarcinoma into the colon, they show in the April issue of Clinical Gastroenterology and Hepatology.
Hemosuccus pancreaticus is defined as hemorrhage from the ampulla of Vater via the pancreatic duct. It most often occurs as a complication of pancreatitis with rupture of a visceral artery aneurysm, but can be caused by trauma or neoplasms.
Sara Chalifoux et al describe the case of a 55-year-old man with stage IV pancreatic adenocarcinoma and 4 days of painless hematochezia. Colonoscopy revealed a single actively oozing diverticulum in the splenic flexure, which was treated with 2 hemoclips.
A repeat colonoscopy 2 days later for recurrent hematochezia showed a hemoclip at the splenic flexure with no active bleeding. Ultrasound revealed a faint vascular signal at a lesion. It was treated with epinephrine injection and 2 additional hemoclips, which stopped the signal.
On day 14 of the patient’s hospitalization, the patient again developed hematochezia. Colonoscopy revealed oozing from the splenic flexure diverticulum, which was treated with epinephrine injection; Doppler ultrasound probe confirmed subsequent absence of a vascular signal. Intermittent bubbling of air was then observed from the diverticulum, and a fistulogram from the colon lumen showed a tract between the pancreatic tail mass and the colon.
Computed tomography analysis shows the pancreatic adenocarcinoma with abscess adjacent to the colon wall (see figure). An exploratory laparotomy showed pancreatic tumor erosion into the proximal descending colon. This was treated with partial colectomy and there was no further bleeding.
The authors state that it is rare to see hemosuccus pancreaticus caused by pancreatic adenocarcinoma. Atypical presentations of GI bleeding provide diagnostic dilemmas, so it is important to consider hemosuccus pancreaticus for patients with pancreatic cancer with gastrointestinal bleeding and no obvious source.