Recurrent upper gastrointestinal bleeding in chronic pancreatitis since childhood: a case report

Abstract

Chronic pancreatitis is a progressive inflammatory disease of the pancreas. Causes of gastrointestinal (GI) bleeding in chronic pancreatitis are bleeding into the pseudocyst, pseudoaneurysm of peripancreatic vessels, and thrombosis of portal vein and splenic vein. We are presenting a rare case presentation of recurrent GI bleed in chronic pancreatitis since childhood and its management. A seventeen-year-old female patient presented with recurrent attacks of upper abdominal pain, hematemesis, bleeding per rectum, and melena since 1 month of age. She was diagnosed with a case of chronic calcific pancreatitis with pseudoaneurysm of common hepatic artery, and portal vein thrombosis with splenomegaly at the age of 2 years. She underwent angioembolization of the common hepatic artery pseudoaneurysm at the age of 2 years. However, she continued to have recurrent episodes of upper GI bleeding which required multiple hospital admissions and blood transfusions in the past. Contrast-enhanced computed tomography of abdomen was suggestive of chronic calcific pancreatitis with status post coil embolization of common hepatic, gastroduodenal, and proper hepatic arteries. She underwent modified Frey’s procedure in view of recurrent symptoms. Currently, the patient is doing well after 18 months of follow-up, with no further episodes of GI bleed. Angioembolization or surgical ligation of pseudoaneurysm of involved vessels in chronic pancreatitis can control GI bleed. However, in cases where the source of bleeding is not localized by imaging/ endoscopy, drainage of pseudocyst or local resection of pancreatic tissue can reduce inflammation in and around the pancreas and prevent further GI bleed in chronic pancreatitis.