Loading [MathJax]/jax/output/HTML-CSS/fonts/TeX/fontdata.js

Journal List > Korean J Gastroenterol > v.70(6) > 1007718

TOOLS
Jo, Kang, Choi, Kim, Kim, Nam, and Ryu: Hemosuccus Pancreaticus in the Simple Mucinous Cyst of the Pancreas
Case Report

Korean J Gastroenterol 2017;70(6):301-303.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.6.301

Hemosuccus Pancreaticus in the Simple Mucinous Cyst of the Pancreas

IL Eok Jo1, 2, Dae Hwan Kang1, 2, , Cheol Woong Choi1, 2, Hyung Wook Kim1, 2, Su Jin Kim1, 2, Hyeong Seok Nam1, 2, Dae Gon Ryu1, 2

1Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea

2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Correspondence to: Dae Hwan Kang, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel: +82-55-360-1535, Fax: +82-55-360-1536, E-mail: sulsulpul@naver.com

Received 9 July 2017       Accepted 7 December 2017

Copyright © 2017 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hemosuccus pancreaticus is an unusual gastrointestinal hemorrhage through the main pancreatic duct. We report a rare case of hemosuccus pancreaticus due to a simple mucinous cyst of the pancreas. A 52-year-old man who had been followed-up for a suspected branch duct intraductal papillary mucinous neoplasm (IPMN) visited the emergency room due to hematochezia. Endoscopy showed active bleeding from the ampulla. Computed tomography revealed hemorrhage in a 2.0-cm cystic mass in the pancreatic body. The patient was diagnosed with hemosuccus pancreaticus caused by bleeding into the main pancreatic duct from suspected IPMN. Elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was a simple mucinous cyst with squamous metaplasia based upon the pathological finding involving the absence of ovarian-type stroma. In conclusion, it should be recognized that a pancreatic cyst including simple mucinous cyst may cause hemosuccus pancreaticus, and these cysts should be viewed as neoplastic and approached similarly as other mucinous pancreatic neoplasms.

Go to : Goto

Keywords: Pancreas, Bleeding, Cysts

References

1. Krasinskas AM, Oakley GJ, Bagci P, et al. "Simple mucinous cyst" of the pancreas: a clinicopathologic analysis of 39 examples of a diagnostically challenging entity distinct from intraductal abdominal mucinous neoplasms and mucinous cystic neoplasms. Am J Surg Pathol. 2017; 41:121–127.
2. Suter M, Doenz F, Chapuis G, Gillet M, Sandblom P. Haemorrhage into the pancreatic duct (hemosuccus pancreaticus): abdominal and management. Eur J Surg. 1995; 161:887–892.
3. Risti B, Marincek B, Jost R, Decurtins M, Ammann R. abdominal pancreaticus as a source of obscure upper gastrointestinal bleeding: three cases and literature review. Am J Gastroenterol. 1995; 90:1878–1880.
4. Kurland J, Matthews T, Hoff E, Gentry A, Cash B. Hemosuccus pancreaticus caused by metastatic renal cell carcinoma. Gastrointest Endosc. 2007; 66:1241–1242.
crossref
5. Shinzeki M, Hori Y, Fujino Y, et al. Mucinous cystic neoplasm of the pancreas presenting with hemosuccus pancreaticus: report of a case. Surg Today. 2010; 40:470–473.
crossref
6. Inoue H, Katurahara M, Hamada Y, et al. Hemosuccus abdominalus caused by in situ carcinoma of the pancreas. Endoscopy. 2012; 44(Suppl 2 UCTN):E336–E337.
7. Kosmahl M, Egawa N, Schröder S, Carneiro F, Lüttges J, Klöppel G. Mucinous nonneoplastic cyst of the pancreas: a novel abdominal cystic change? Mod Pathol. 2002; 15:154–158.
8. Vege SS, Ziring B, Jain R, Moayyedi P; Clinical Guidelines Committee; American Gastroenterology Association. American gastroenterological association institute guideline on the abdominal and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015; 148:819–822. quize 12–13.
Go to : Goto

kjg-70-301f1.tif
Fig. 1.
(A) Two cystic masses in the pancreas body (0.8 cm, thick arrow) and tail (2.0 cm, thin arrow) were seen on contrast enhanced abdominal CT 8 months prior. (B) About 1.2 cm sized cystic mass in the pancreatic body, connected with main P-duct was seen on MRI (T1) after 3 months. The cystic mass at the pancreas tail was resorbed. (C) Hemorrhage in the 2.0 cm cystic mass of the pancreatic body was seen on the contrastenhanced abdominal CT. CT, computed tomography; MRI, magnetic resonance imaging.
undefined
kjg-70-301f2.tif
Fig. 2.
Blood was detected from the major papilla by esophagogastroduodenoscopy.
undefined
kjg-70-301f3.tif
Fig. 3.
(A) No papillary epithelium is seen. The normal epithelium layer is destroyed (thick arrow) (H&E, ×50). (B) Partial squamous metaplasia is seen (arrows) (H&E, ×100). (C) Mucinous epithelium without ovarian-type stroma is seen (H&E, ×200).
undefined
TOOLS
Similar articles