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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 100-101

Hemosuccus pancreaticus caused by a mucinous cystadenoma of the pancreas


Department of General Surgery, Celia Sánchez Manduley Hospital, Manzanillo, Granma, Cuba

Date of Submission09-Dec-2020
Date of Decision10-Dec-2020
Date of Acceptance10-Dec-2020
Date of Web Publication23-Jan-2021

Correspondence Address:
Dr. Fernando Karel Fonseca Sosa
Esperanza Street #73 between Guadalupe and San Javier, Manzanillo, Granma, Postal Code 87510
Cuba
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_162_20

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How to cite this article:
Fonseca Sosa FK, Ramos Socarrás AE, Casado Méndez PR, Olivera YM. Hemosuccus pancreaticus caused by a mucinous cystadenoma of the pancreas. Indian J Med Spec 2021;12:100-1

How to cite this URL:
Fonseca Sosa FK, Ramos Socarrás AE, Casado Méndez PR, Olivera YM. Hemosuccus pancreaticus caused by a mucinous cystadenoma of the pancreas. Indian J Med Spec [serial online] 2021 [cited 2021 Apr 14];12:100-1. Available from: http://www.ijms.in/text.asp?2021/12/2/100/307704



The term hemosuccus pancreaticus was first proposed by Sandblom in 1970. It is defined as a gastrointestinal bleeding through the main pancreatic duct and is a rare cause of gastrointestinal hemorrhage. It is caused by a bleeding source in the pancreas, pancreatic duct, or structures adjacent to the pancreas. In some rare cases, It can be caused by pancreatic tumors including mucinous cystic neoplasm.[1]

We present the case of a 44-year-old female, who came to the emergency department presenting with melena from the previous day, pain in the upper left abdominal quadrant of 10 months of evolution, which appeared after the ingestion of foods rich in fats, intermittent, without radiation, which was alleviated with the usual analgesics, accompanied by nausea. Bioparameters were normal. When performing digital rectal examination, the melena was confirmed. A nasogastric tube was placed, gastric lavage and aspiration were performed, obtaining a clear aspirate without blood or bile.

Laboratory tests showed an anemia (hemoglobin 11g/dL and hematocrit of 35%), the rest of the tests were normal. Esophagogastroduodenoscopy was performed. In the second portion of the duodenum, clots were observed adjacent to the Vater papilla without being able to define ulcerous lesion. Abdominal ultrasound revealed a predominantly liquid complex image in pancreatic projection. Abdominal computed tomography showed a hypodense lesion of contours well defined, with a thin wall and multiple internal septa, measuring 116 cm × 74 cm located in the pancreatic tail.

Elective intervention was effected with the preoperative diagnosis of cystic tumor of the tail of the pancreas. A supraumbilical left paramedia incision was performed, the transcavity of the omentum was accessed through the gastrocolic ligament, identifying a cystic tumor of 10 cm in the body and tail of the pancreas, without other injuries. A distal pancreatectomy was completed with splenectomy [Figure 1]. Histology described a multilocular cystic with mucinous and hemorrhagic material. The wall was lined with mucin-producing columnar epithelium surrounded by a stroma similar to that of the ovary, without cellular atypia. Communication with the pancreatic duct was identified through a fistulous tract. It was concluded as a pancreatic mucinous cystadenoma. The patient's postoperative course was uneventful and she is now asymptomatic.
Figure 1: (a) Intraoperative picture showing the distal pancreatectomy. The white arrow indicates the upper mesenteric vein. (b) Resected cystic tumor

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Pancreatic mucinous cystadenoma is one of the histological varieties of mucinous cystic neoplasm. It is defined as an epithelial neoplasm that presents an ovarian-like stroma on which a mucin-producing columnar epithelium rests and has no communication with the main pancreatic duct or its branches, unless a lesion communicant or fistula has formed.[2]

The cause of bleeding is attributed to the fact that this neoplasm communicates with the duodenum through the pancreatic duct.[3] However, it has been reported that communication between this neoplasm and pancreatic ducts is rarely observed. When hemosuccus pancreaticus due to pancreatic cystic neoplasms is properly diagnosed and surgically treated, the prognosis seems to be relatively good.[4] Surgical resection is curative in nearly all patients with noninvasive mucinous cystic neoplasm. The current consensus guideline advocates that all should be resected, unless there are contraindications for operation.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yu P, Gong J. Hemosuccus pancreaticus: A mini-review. Ann Med Surg (Lond) 2018;28:45-8.  Back to cited text no. 1
    
2.
Bolívar DJ, Arango LA, González R, Díaz CP, Sánchez A. Mucinous neoplasms of the pancreas: clinical case and review of the literature. Rev Colomb Gastroenterol 2018;33:301-7.  Back to cited text no. 2
    
3.
González F, Pinto A. Upper gastrointestinal bleeding in a patient with mucinous cystadenoma of the pancreas. Rev Chil Cir 2017;69:73-6.  Back to cited text no. 3
    
4.
Matsumoto Y, Miyamoto H, Fukuya A, Nakamura F, Goji T, Kitamura S, et al. Hemosuccus pancreaticus caused by a mucinous cystic neoplasm of the páncreas. Clin J Gastroenterol. 2017; 10:185-90.  Back to cited text no. 4
    
5.
Brugge WR. Diagnosis and management of cystic lesions of the páncreas. J Gastrointest Oncol 2015;6:375-88.  Back to cited text no. 5
    


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