Cause Of Gastrointestinal Bleeding Research Articles

Role of octreotide in small bowel bleeding.

Gastrointestinal bleeding accounts for a drastic negative impact on the quality of the patients’ lives as it requires multiple diagnostic and therapeutic interventions to identify the source of the bleeding. Small bowel bleeding is the least common cause of gastrointestinal bleeding. However, it is responsible for the majority of complaints from patients with persisting or recurring bleeding where the primary source of bleeding cannot be identified despite investigation. A somatostatin analog known as octreotide is among the medical treatment modalities currently used to manage small bowel bleeding. This medication helps control symptoms of gastrointestinal bleeding by augmenting platelet aggregation, decreasing splanchnic blood flow, and antagonizing angiogenesis. In this review article, we will highlight the clinical efficacy of octreotide in small bowel bleeding and its subsequent effect on morbidity and mortality.

Intestinal arteriovenous malformations: a diagnostic and therapeutic challenge

Arteriovenous malformations (AVM) of the intestine are rare causes of gastrointestinal bleeding. Diagnosis depends upon accurate interpretation of imaging features and histopathology to differentiate them from other vascular malformations. Presentation of colonic AVM with mucous diarrhea and pain is rare and poses diagnostic challenges. Usually, patients presenting with bleed need surgical intervention. The current report discussed one patient with chronic liver disease, extrahepatic portal vein thrombosis with small bowel AVM and two patients with colonic AVM, highlighting management strategies adopted.

Jejunal Dieulafoy's Lesion as a Rare Cause of Massive Gastrointestinal Bleeding; a Case Report and Literature Review.

Jejunal Dieulafoy's lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopy was normal, and the colon was full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding from the nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy’s lesion. It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy’s lesion should be included in the differential diagnoses.

Acute Esophageal Necrosis. A Case Report.

Acute esophageal necrosis syndrome, is a rare cause of gastrointestinal bleeding. It is characterized by a particular black coloration, mostly of the distal esophagus, which ends abruptly in the gastroesophageal junction. The hemorrhagic manifestation may be hematemesis, melena or both of them. It is a life-threatening condition with significant difference between the two sexes.We report a case of a 67 years old male with schizophrenia, aspiration pneumonia and sepsis who presented with hematemesis. The endoscopic finding was a black, wide linear necrosis of the esophageal mucosa which extended from the middle esophagus to the gastroesophageal junction, compatible with acute esophageal necrosis. The esophageal lesion healed progressively at the same time with the improvement of the general health condition.
 We must think of acute esophageal necrosis in critically ill male patients, in their sixth decade of life, with multiple comorbidities and gastrointestinal hemorrhage, because early recognition can help reducing the mortality of this rare syndrome.
 In conclusion, we must think of acute esophageal necrosis in critically ill male patients, in their sixth decade of life, with multiple comorbidities and gastrointestinal hemorrhage. The diagnostic is made most of the time only by the characteristic endoscopic findings. Because of the gravity of this affection, the treatment must be quick and aggressive.

Computed tomography in intestinal angiodysplasia diagnosis using clinical cases example

Intestinal angiodysplasia is a vascular pathology of the intestinal wall, one of the causes of gastrointestinal bleeding, the severity of which can vary from latent to life-threatening. Patients of this group, according to vital indications, as a rule, are admitted to general surgical hospitals, where, due to the rare occurrence of pathology, there are no well-developed treatment and diagnostic algorithms, which leads to misrecognition of the source of bleeding and unreasonable surgical interventions. To demonstrate the possibilities of computed tomography with bolus intravenous contrast in the detection of intestinal angiodysplasia. Patients sought medical help in a hospital with recurrent gastrointestinal bleeding. Abdominal and pelvic CT using intravenous bolus contrast and multi-phase scanning was performed on 64- and 128-slice CT scanners. Post-processing included analysis of standard reconstructions, MIP and 3D VRT algorithms. Cases represent the main angiographic signs of intestinal angiodysplasia, such as: abnormal vascular network in the intestinal wall, dilatation of the great vessels supplying angiodysplasia, early contrast enhancement of the efferent vein. Evaluation of the MIP and 3D VRT algorithms makes it possible to identify these pathological changes more confidently. To date, computed tomography with bolus intravenous contrast is the most accessible non-invasive diagnostic method that allows to identify and localize intestinal angiodysplasia and, in combination with endoscopic investigative methods, confirm the diagnosis and exclude other pathology characterized by a similar clinical presentation, which helps to choose the correct treatment tactics.

A rare cause of small bowel bleeding

We present a rare cause of gastrointestinal bleeding resulting from fistulae between the mesenteric artery and portal venous system, caused as a late complication of sleeve gastrectomy. A high index of suspicion, based upon venous engorgement without an occluding thrombus, enabled prompt diagnosis and occlusion of the fistulae with coils, leading to marked clinical improvement.

Severe low gastrointestinal bleeding due to Dieulafoy's lesion: A report of two cases and review of literature

AbstractMassive low gastrointestinal bleeding is an uncommon but severe event. Dieulafoy's lesion is a rare cause of gastrointestinal bleeding but associated with a high mortality rate. In this report, we describe two cases of massive low gastrointestinal bleeding due to Dieulafoy's lesion of the colon who were successfully treated with endoscopic therapy, despite severe bleeding with inadequate bowel preparation. These two cases emphasize the importance of careful endoscopic evaluation to investigate gastrointestinal bleeding and that rare entities should be considered in the differential diagnosis of common clinical presentations.

Diagnosis and treatment of diverticular hemorrhage in small intestine: A retrospective study

Background and study aimsSmall intestine diverticula are the most common cause of gastrointestinal hemorrhage, but prompt diagnosis remains challenging. Thus, this study aimed to identify strategies for the diagnosis and treatment of diverticular hemorrhage. Patients and methodsPatients who presented with gastrointestinal tract bleeding to Guangzhou First People's Hospital between 2008 and 2014 were retrospectively examined. Gastrorrhagia and colonic hemorrhage were excluded based on the gastroscopy and colonoscopy findings, and the bleeding sites were in the small intestine. Data regarding patient characteristics, methods of diagnosis, treatment, and prognosis were collected. ResultsEighty-five patients met the study criteria, and 45 patients were diagnosed with diverticular hemorrhage using double balloon enteroscopy, capsule endoscopy, computed tomography (CT), or digital subtraction angiography (DSA). Among these patients, 10 presented with massive bleeding and hemodynamic instability. All 45 patients underwent surgery and recovered with no complications, and all patients were followed-up for over 3 years, with no cases of recurrent hemorrhage. ConclusionDiverticular hemorrhage is the most common cause of small intestine bleeding. Double balloon enteroscopy, capsule endoscopy, CT, and DSA are effective methods for diagnosing small intestine diverticular hemorrhage. Surgical resection of the involved region is necessary and may achieve complete cure.

CLINICAL CHARACTERISTICS AND CAUSES OF GASTROINTESTINAL BLEEDING IN CHILDREN

Abstract: Background: Gastrointestinal bleeding (GI) is a complication of many diseases, caused by injury at the gastrointestinal tract or outside the gastrointestinal tract, causing bleeding from mild to severe severity, which can even cause shock and death. The causes of gastrointestinal bleeding vary by age. Objectives: To describe the clinical, subclinical and common causes of non-infectious gastrointestinal bleeding in children. Subjects and methods: Patients from 2 months to 15 years old admitted to Pediatrics Department I, Pediatric Center, Hue Central Hospital from February 2020 to February 2021 with a diagnosis of gastrointestinal bleeding. The study was carried out by cross-sectional descriptive research method. Results: The study included 116 patients, 7 children in the group of 2 months - < 1 year old (6.0%), 36 children in the group 1 - < 6 years old (31%), 36 children in the group 6 - < 11 years old (31.1%) and 37 children in the group of 11-15 years old (31.9%). The mean age was 7.6 ± 4.6. Peptic ulcer disease is the most common cause of GI bleeding, accounting for 37%; 12.9% cases unknown cause. Most of the patients had mild and moderate GI bleeding, about 60.3% and 23.3%; severe bleeding 8.6% and very severe 7.8%. The most common cause of GI bleeding in the group of 2 months - < 1 year old is Mallory-Weiss syndrome and milk protein allergy (22.2%), in the group of 1-5 years old is anal fissure (41.6%) and in children over 6 years old is peptic ulcer disease. Conclusion: The most common causes of gastrointestinal bleeding depend on the age and have different clinical features depending on the cause. Key words: gastrointestinal bleeding in children, melena, hematemesis, hematochezia.

Coats plus syndrome: a rare cause of severe gastrointestinal tract bleeding in children \u2013 a case report

BackgroundCoats plus syndrome, cerebroretinal microangiopathy with calcifications and cysts, is a rare disease with autosomal recessive pattern occurring due to a mutation in CTC1, encoding conserved telomere maintenance component 1, gene. Besides retinal involvement, abnormalities in brain and osteopenia, serious life-threatening bleeding in gastrointestinal tract and portal hypertension can be observed.Case presentationA 6-year-old girl with Coats plus syndrome presented to the pediatric emergency department with vomiting blood and blood in stool. An upper and lower gastrointestinal endoscopy revealed esophageal varices and vascular telangiectasia in the pyloric antrum, duodenum, and colon. She received palliative care and the bleeding was stopped after receiving intravenous octreotide. She then was followed in the pediatric gastroenterology, neurology, and ophthalmology clinics. She was later hospitalized and admitted to the intensive care unit as she continued to have intermittent gastrointestinal system bleeding. She eventually died due to severe gastrointestinal system bleeding.ConclusionsCoats plus syndrome can lead to life-threatening gastrointestinal bleeding and portal hypertension. As Coats plus syndrome is quite rare, there is little published data on this syndrome. This report presents a case of Coats plus syndrome as a rare cause of gastrointestinal bleeding and portal hypertension.

A118 UPPER GASTROINTESTINAL HEMORRHAGE SECONDARY TO SUPERIOR MESENTERIC ARTERY PSEUDOANEURYSM: CASE REPORT AND REVIEW OF LITERATURE

BackgroundVisceral artery pseudoaneurysms (VAPAs) are rare with an estimated incidence of 0.1%-0.2%. Due to various etiologies, a tear occurs in the vessel wall with subsequent formation of a peri-artery hematoma. A ruptured VAPA is a clinical emergency due to life-threatening hemorrhage and is associated with mortality rates of 25%-75%.AimsWe report a case of upper gastrointestinal (GI) hemorrhage secondary to a ruptured superior mesenteric artery (SMA) pseudoaneurysm. A review of the literature regarding management of VAPAs and SMA pseudoaneurysms was performed using relevant medical subject headings on PubMed.MethodsA 66-year-old woman presented to hospital with sudden large volume hematemesis and melena. Her daily medications included Aspirin and Atorvastatin. She had no prior history of peptic ulcers or chronic liver disease. She was found to be tachycardic and hypotensive. Initial investigations demonstrated a hemoglobin of 42g/L and a blood urea nitrogen of 17.5mmol/L. She was resuscitated and referred for an emergent upper endoscopy. On endoscopy, in the third portion of the duodenum, a 4cm solid-appearing subepithelial lesion with central umbilication and an apparent visible vessel was identified. Upon inspection of the lesion, the umbilicated area spontaneously began spurting blood (Image 1). A hemoclip was immediately placed next to the lesion for localization, then hemostatic powder was applied to the area. An immediate computerized tomography (CT) angiography of the abdomen revealed a 3.9 x 2.1 cm pseudoaneurysm arising from the superior mesenteric artery impressing upon the duodenum.ResultsTranscathether arterial embolization of the SMA pseudoaneurysm was performed, during which two Nester coils were deposited in the ileocolic outflow vessel. A covered endovascular stent was also deployed across the culprit arterial branch to exclude the pseudoaneurysm. Following the procedure, the patient stabilized and had no further GI bleeding. Traditionally, visceral angiography has been the gold standard diagnostic test for VAPAs, but has now been supplanted by CT angiography. Treatment strategies of VAPAs can be broadly separated into endovascular methods (coils, vascular plugs, stents, liquid embolic agents) and surgical methods (aneurysmectomy with patching, end-to-end anastomosis, bypass grafting).ConclusionsSMA pseudoaneurysms are a rare yet life-threatening cause of GI bleeding. Endoscopically, they resemble solid subepithelial masses, such as GI stromal tumor, nerve sheath tumor or a lipoma, which may lead to inappropriate attempts to biopsy the lesion or apply direct endoscopic therapy. Prompt diagnosis with imaging, such as CT angiography, is paramount with a view to definitive treatment of the pseudoaneurysm via endovascular methods. Actively hemorrhagic SMA pseudoaneurysmFunding AgenciesNone

A137 AN ELUSIVE GASTROINTESTINAL BLEED: A CASE OF RUPTURED CYSTIC ARTERY PSEUDOANEURYSM WITH PREVIOUS BILLROTH-II SURGERY

Abstract Background Cystic artery pseudoaneurysm (CAP) is a rare but potentially life-threatening cause of upper gastrointestinal (GI) bleeding and requires urgent intervention. Aims To describe the clinical enigma of CAP in the context of distorted anatomy and discuss management. Methods Case report and review of literature Results Case Report A healthy 91-year-old man with a remote history of gastric ulcer perforation leading to Billroth-II surgery 40 years ago presented to a community hospital with melena. He had no abdominal pain and liver enzymes were normal. His hemoglobin was 97 g/L (from 137 g/L the month prior) with a BUN:Cr ratio of 50.6 mg/dL and white cell count of 14.4 x109/L. Upper endoscopy identified a large adherent clot in the stomach that could not be dislodged and was suspected to obscure the culprit lesion. Afferent and efferent limbs from previous Billroth-II surgery were identified but not intubated. He was managed supportively with acid suppression and blood transfusion, but his hemoglobin continued decreasing, leading to transfer to a tertiary centre. Upon arrival he had new-onset abdominal pain, rigors, and diaphoresis with a heart rate of 175 beats/minute and blood pressure of 75/40 mmHg. After resuscitation, emergent CT angiogram demonstrated acute contrast extravasation into the gallbladder in keeping with a ruptured CAP. He underwent successful coiling of the cystic artery. Following this, his abdominal pain resolved, and hemoglobin stabilized. Repeat endoscopy demonstrated Billroth-II anatomy without bleeding lesion. He was treated with antibiotics for presumed cholecystitis and discharged home for outpatient cholecystectomy. Literature Review CAP is a rare cause of hemobilia, described only in case reports. The complete hemobilia triad of jaundice, right upper quadrant pain, and GI bleeding is absent in the majority of cases, requiring endoscopic evaluation of the ampulla of Vater or contrast CT. The most common causes of CAP are iatrogenic from cholecystectomy, cholecystitis, gallstones, and malignancy. These mechanisms, whether through trauma or inflammation, lead to damage of the gallbladder wall and the cystic artery. Contained CAP can lead to intermittent bleeding whereas ruptured CAP causes brisk arterial bleeding, necessitating arterial embolization or emergent cholecystectomy. In cases of biliary obstruction, either from the original process or subsequent blood clot at the ampulla, ERCP can lead to successful decompression. Conclusions We present a case of ruptured CAP which eluded diagnosis due to diagnostic rarity, lack of clinical clues, and distorted anatomy. CAP should be considered with a history of recent cholecystectomy, acute cholecystitis, or gallstones. Maintaining an index of suspicion for rare causes of GI bleeding can ensure timely diagnosis and escalation to the appropriate level of care. Funding Agencies None

Inpatient outcomes of Dieulafoy’s lesions in the United States

Dieulafoy’s lesions are arguably underidentified rather than an infrequent cause of gastrointestinal bleeding. No population-based study exists regarding its inpatient outcomes in the United States. We evaluated the characteristics and inpatient outcomes for Dieulafoy’s lesions using the National Inpatient Sample from 2016 to 2019. We identified 30,015 weighted hospitalizations for Dieulafoy’s lesions. An initial diagnosis of Dieulafoy’s lesions was established for 53.85% of patients on admission. The mean age was 68.7 ± 0.04 years, with male (56%) and white race predominance (70%). The mean length of stay and hospital cost were 7.87 days and $111,914, respectively. Significant predictors of inpatient mortality included heart failure, cardiac arrhythmias, coagulopathy, protein-calorie malnutrition, and alcoholism (P < 0.001). During inpatient hospitalization, 78% of patients underwent endoscopies, and 11% had colonoscopies. Inpatient mortality was 4.65%. Common comorbidities in Dieulafoy’s lesions patients included heart failure (34%), cardiac arrhythmias (41%), hypertension (32%), chronic obstructive pulmonary disorders (25%), coagulopathic disorders (22%), and alcohol abuse (12%). Dieulafoy’s lesions have a significant effect on length of stay and hospital cost. Endoscopies were used substantially more than colonoscopies for Dieulafoy’s lesions, indicating a predominant presentation as upper gastrointestinal bleed. Cardiac disorders increase mortality in patients with Dieulafoy’s lesions.

To coagulate, ligate, or both: a randomized study comparing the safety and efficacy of two endoscopic approaches for managing gastric antral vascular ectasia in cirrhotic patients

BackgroundGastric antral vascular ectasia (GAVE) is an uncommon but important cause of gastrointestinal bleeding in cirrhotic patients. Argon plasma coagulation (APC) is the standard therapy for GAVE. Endoscopic band ligation (EBL) is an emerging, safe and effective treatment for GAVE. The best way of applying EBL in the management of GAVE is not clear yet.AimWe aimed to determine the safety and efficacy of APC alternating with EBL versus EBL alone for managing GAVE in cirrhotic patients.Patients and methodsForty cirrhotic patients with bleeding GAVE were randomized to receive either APC alternating with EBL (20 patients) or EBL alone (20 patients) until GAVE lesions are eradicated. Gastroscopy was done 6 months after eradication of GAVE lesions to document recurrence. Cessation of bleeding, rise of hemoglobin level, need for transfusion, hospitalization, complications, number of sessions, and recurrence of GAVE in both groups were statistically analyzed.ResultsPatients in both groups showed significantly high rate of bleeding cessation, improvement in hemoglobin levels, reduction in transfusions, and hospitalizations. There was no statistically significant difference regarding the recurrence of GAVE between the two groups. There were no complications seen in the combined therapy group. Twenty percent of the patients in the EBL group had complications including hypertrophied polyp formation and post-band ulcerations.ConclusionAPC alternating with EBL and EBL alone are effective methods in the treatment of bleeding GAVE. Combined therapy has the potential to decrease the number of banding sessions and the number of rubber bands required to treat GAVE, consequently decreasing the incidence of band-related complications.

ESOPHAGOGASTRIC VARICEAL BLEEDING AS DEBUT OF CAROLI�S SYNDROME: A REPORTED CASE

Caroli's disease is a congenital disease characterized by saccular or cystic dilatations of intrahepatic bile ducts. It is called Caroli's syndrome (CS) when intrahepatic dilations are associated with congenital hepatic fibrosis. CS is an infrequent cause of gastrointestinal bleeding in young people that should be considered when saccular dilatations of the bile duct are associated with portal hypertension (PHT). We present a rare case with gastrointestinal bleeding as first manifestation of CS: A 13-year-old woman with no relevant medical history was admitted to the hospital with an episode of hematemesis.

Angiodysplasia and its correlation to serum magnesium level in patients with chronic kidney disease stage 5D under maintenance hemodialysis

Background Angiodysplasias (ADs) are vascular ectasias not associated with any familial syndrome, cutaneous lesions, or systemic vascular disease. They are the most common vascular malformations of the gastrointestinal tract in the general population with a prevalence of 0.82%. Most AD occurring in the general population are detected in patients older than 60 years of age, although presentation in patients with chronic kidney disease (CKD) can be earlier. The aim was to correlate AD with serum magnesium level in patients with CKD stage 5D under maintenance hemodialysis. Patients and methods This study included 60 patients with CKD stage 5D on maintenance hemodialysis. Upper and lower gastrointestinal tract endoscopy was done for all patients in Kafr Elsheikh University Hospital in a cross-sectional ‘prospective study,’ and all laboratory investigations were done. Results The mean age of patients with CKD was 49.03±14.66 years. There was a statistically significant increase in Mg among patients with AD and those without AD. This study showed that there were statistically significant negative correlations between Mg and parathyroid hormone. Conclusion AD is one of the common causes of gastrointestinal bleeding in all population and is the most common cause of bleeding in patients with CKD. Hypermagnesemia is associated with AD in patients with CKD.

COMPLICATION ASSOCIATED WITH UPPER GASTROINTESTINAL BLEEDING AMONG MEXICAN PATIENTS WITH CIRRHOSIS

Upper gastrointestinal bleeding is a common complication among cirrhotic patients and holds high mortality and morbidity; the most common cause is variceal hemorrhage. Nonetheless, non-variceal hemorrhage is also frequent; this study aims to determine the prevalence of upper gastrointestinal bleeding complications among Mexican patients with cirrhosis. Retrospective, cross-sectional, an analytic study among patients with cirrhosis of all etiologies admitted to the Gastroenterology department of the Hospital General de Mexico “Dr. Eduardo Liceaga” with acute upper gastrointestinal bleeding of both etiologies (variceal and non-variceal hemorrhage) in the period comprised from January 2017 to May 2021. Complications associated with the bleeding events were evaluated. For statistical analysis, quantitative variables were described as mean and standard deviation for qualitative variables in frequencies and percentages. A total of 295 patients were included, 55.3% male, mean age was 54.6 ± 11.8 years, 16.27% patients were staged as Child A, 49.15% Child B y 34.57% Child C, with and an average MELD score of 16. Main cirrhosis etiology was alcohol-related liver disease in 39.7%, viral hepatitis 6.4%, NASH 5.8% and others 3.4%; however, in 44.7% of patients, we were not able to determine the etiology of liver disease. The main cause of gastrointestinal bleeding was variceal hemorrhage in 71.1% and 28.9% non-variceal. The shock was identified in 5.76% (17) of patients, 9 of them required vasopressors, hepatic encephalopathy was present in 42.71% (126), Ascites in 18.64% (55), jaundice in 16.94% (50), acute kidney injury in 31.52% (93), bacterial infections in 24.06% (71), four patients (1.35%) died. Complications related to gastrointestinal bleed according to disease severity are depicted in table 1. Complications associated with upper gastrointestinal bleeding among Mexican patients with cirrhosis are frequent. Encephalopathy is the most common (42.71%) followed by acute kidney injury (31.52%) preponderantly of high grade, patients with more advanced disease are more prone to present infections, mainly UTI and ascites. Therefore they must be monitored closely. The authors declare that there is no conflict of interest.

Laparoscopic treatment in gastrointestinal bleeding due to Dieulafoy's lesion.

Dieulafoy's lesion is a rare cause of gastrointestinal bleeding. Produced by the erosion of aberrant vessels in the submucosa, usually at the gastric level. The jejunal location is unusual. Its diagnosis is complicated by the intermittent characteristic of bleeding, initially recommending the endoscopic approach. It is an unusual entity that must be taken into account in the differential diagnosis of gastrointestinal bleeding. Massive bleeding can occur, compromising the life of the patient. Initial endoscopic/radiological management is recommended, reserving the surgical approach for refractory bleeding for less invasive treatments.

Haemosuccus pancreatitis: A rare cause of GI bleed, diagnosis on CT Angiography – Case series &amp; review of literature

Haemosuccus pancreatitis also known as Pseudohaemobilia or haemoductal pancreatitis, is defined as upper gastrointestinal hemorrhage originating from the pancreatic duct into the duodenum via the Ampulla of Vater, or major pancreatic papilla. A triad of epigastric pain, intermittent gastro intestinal bleeding and hyperamylasemia [1,2]. We present three cases of chronic pancreatitis presenting as upper GI bleed and with epigastric pain and sudden drop in Hematocrit. One had bleed from pseudo aneurysm arising from hepatic artery leaking into pseudo cyst, second had erosion of wall of splenic vein leaking into pancreatic duct through small pseudocyst and the third patient was post cystojejunostomy with who bled into cyst, probably from a vessel in wall of cyst, well demonstrated on venous phase of CT angiography and later responded to conservative management. Hemorrhage from the pancreatic duct, i.e. Haemosuccus Pancreaticus (HP), is a rare cause of gastrointestinal bleeding. Pancreatic Homosuccus is usually due to the rupture of an aneurysm of a visceral artery, most likely the splenic artery, in chronic pancreatitis. Other causes of HP are rare. Keywords: haemosuccus pancreaticus; pseudo aneurysm; pancreatitic pseudocyst; upper gastrointestinal bleeding; embolization.

Case Report: Portal cavernoma related to multiple liver hydatidosis: A rare case of fatal cataclysmic haemorrhage.

Clinical presentation of liver hydatidosis can vary from asymptomatic forms to lethal complications. We report herein a rare case of a 27-year-old male from a rural Tunisian region who presented with large-abundance haematemesis, haemodynamic instability, and marked biological data of hypersplenism. Endoscopy showed bleeding esophageal varicose veins that were ligated. Abdominal ultrasound concluded the presence of three type CE2 hydatic liver cysts causing portal cavernoma with signs of portal hypertension. Despite resuscitation, the patient died of massive rebleeding leading to haemorrhagic shock. Hepatic hydatid cyst should be considered as an indirect cause of gastrointestinal bleeding in endemic countries. Early abdominal ultrasound in varicose haemorrhage is essential in orienting the diagnosis.