[Hemosuccus pancreaticus due to a pressure ulcer in pancreatolithiasis]

Abstract

Ultrasound examination in a 32-year-old man with epigastric pain and slightly elevated serum amylase level (66 U/l) revealed cysts in the head and tail of the pancreas as well as nonhomogeneous pancreas parenchyma as signs of chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) additionally showed pancreatolithiasis. Melena occurred 7 months later, haemoglobin concentration decreasing to 8.7 g/dl. Endoscopy revealed bleeding into the duodenum via the papilla major. Angiography excluded vessel rupture. Haemostasis was achieved by occlusion of the pancreatic duct with fibrin glue, but the procedure had to be repeated twice within the next 8 months. Three months later ERCP was performed because of melena with massive haematemesis (haemoglobin level 6.5 g/dl). Stones were no longer demonstrated. At the previous location a pressure ulcer was now demonstrated, together with fresh blood in the pancreatic duct. After the stones had passed the ulcer healed and the patient has been symptom-free for over 13 months.