An Unusual Cause of Upper Gastrointestinal Bleed: A Case Report and Brief Review of Literature

A case of a 48-year-old female, who presented with refractory haemetemesis. Her oesophagogastroduodenoscopy
showed only a healing ulcer but profuse bleeding was seen from duodenum. In
spite of a negativeoesophago-gastroduodenoscopy she was bleeding profusely with hemodynamic
decompensation. Doppler coeliac trunk showed a supra pancreaticcystic lesion with yin-yang pattern
of blood flow confirming a pseudo aneurysm involving the superior and inferior pancreatioduodenal
arterial arcade using digital subtraction angiography. The conversion of a pancreatic pseudo cyst into
a pseudo aneurysm is potential lethal complication because, when rupture occurs, mortality rises up
to 40%. She was diagnosed to have pancreatic pseudocyst, psedoaneurysm and haemosuccus
pancreaticus with wirsungorrhagia and was offered arterial embolization following which she
improved. Patients with chronic calcificpancratitis (CCP) could remain silent and can present with
normal amylase and lipase. Complications such as pseudo cysts orpseudoaneurysms can be
asymptomatic. The pancreas should be considered a possible site of hemorrhage in CCP in cases of
refractory upper gasrtrointestinal haemorrhage. We highlight the importance of looking for causes
other than bleeding duodenal/gastric ulcer/oesophageal varices in case of a refractoryhametemeis
giving the patient option of a nonsurgical modality of treatment and it’s reducedrisks. The
effectiveness of embolisation for bleeding psuedoaneurysms is emphasized.