title: Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre.
abstract: Background. Hemosuccus pancreaticus (HP) is a very rare and obscure cause of upper gastrointestinal bleeding. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Methods. We retrospectively reviewed the records of all patients who presented with HP over the last 15 years at our institution between January 1997 and December 2011. Results. There were a total of 51 patients with a mean age of 32 years. Nineteen patients had chronic alcoholic pancreatitis; twenty-six, five, and one patient had tropical pancreatitis, acute pancreatitis, and idiopathic pancreatitis, respectively. Six patients were managed conservatively. Selective arterial embolization was attempted in 40 of 45 (89%) patients and was successful in 29 of the 40 (72.5%). 16 of 51 (31.4%) patients required surgery. Overall mortality was 7.8%. Length of followup ranged from 6 months to 15 years. Conclusions. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition.
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: Ashwin
authors: 0000-0001-9528-8892
authors: A
authors: Rammohan
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: Ravichandran
authors: R
authors: Palaniappan
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: Sukumar
authors: S
authors: Ramaswami
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: Senthil Kumar
authors: SK
authors: Perumal
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: Anand
authors: A
authors: Lakshmanan
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: U P
authors: UP
authors: Srinivasan
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: Ravi
authors: R
authors: Ramasamy
authors: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
authors: Jeswanth
authors: J
authors: Sathyanesan