2019 Volume 39 Issue 5 Pages 871-874
A 47-year-old man under follow-up for chronic pancreatitis presented to our hospital with tarry stools and bloody vomiting. On admission, he presented in shock with severe anemia. Emergency esophagogastroduodenoscopy showed copious amounts of old blood in the stomach and duodenum, but the bleeding point could not be identified. His vital signs were improved by fluid resuscitation and blood transfusions. However, on the next morning, he once again went into shock with severe anemia. An endoscopic examination was performed again, and revealed active bleeding from a ampulla of Vater. As he had a lethal iodine allergy resulting in cardiac arrest, some diagnostic modalities using iodine, such as ERCP, enhanced CT and arterial angiography, were prohibited. Radiological intervention was also prohibited. We therefore performed abdominal US, plain CT and Gd-enhanced MRI examinations as diagnostic modalities. Finally we diagnosed hemosuccus pancreaticus due to intracystic massive hemorrhage at the pancreatic tail pseudocyst and we performed an emergency distal pancreatectomy. The patients state of shock and anemia improved rapidly after surgery. Histopathological examination revealed intracystic hemorrhage at the pancreatic tail pseudocyst.
