Acute upper gastrointestinal bleeding – a rare manifestation of pancreatic adenocarcinoma

Czech version

Authors: A. Orságh ¹; M. Ondrejkovičová ¹; M. Bátovský ¹; R. Hrčka ¹; Z. Lišková ²
Authors‘ workplace: Gastroenterologická klinika SZU a UNB, Nemocnica sv. Cyrila a Metoda, Bratislava ¹; Rádiológia s. r. o., Nemocnica sv. Cyrila a Metoda, Bratislava ²
Published in: Gastroent Hepatol 2014; 68(3): 243-247
Category: Clinical and Experimental Gastroenterology: Case Report

Overview

The case study presents a patient suffering from a pancreatic adenocarcinoma infiltrating the duodenum at part D3, initially manifested by acute upper gastrointestinal bleeding. The bleeding was haemodynamically severe, recurrent and ultimately fatal. Pancreatic cancer is rarely manifested by acute gastrointestinal bleeding. It is mostly due to the direct invasion of GIT, usually in the duodenum. In general, tumours are the cause of bleeding in the upper GI tract in only about 2.9% of all cases. Endoscopic treatment of tumour-induced GI bleeding is often complicated and inadequate. In those cases, the methods of interventional radiology and surgery could be applied.

Key words:
pancreatic adenocarcinoma – upper gastrointestinal bleeding – melena – hematemesis – endoscopy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
6. 11. 2013

Accepted:
9. 3. 2014

Sources

1. British Society of Gastroenterology Endoscopy Commitee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002; 51 (Suppl 4): 1–6.

2. Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am 2008; 92(3): 491–509. doi: 10.1016/j.mcna.2008.01.005.

3. Elta GH, Takami M. Approach to the patient with gross gastrointestinal bleeding. In: Yamada T (ed.). Principles of clinical gastroenterology. Oxford: Blackwell Publishing 2008: 123–137.

4. Tavakkolizadeh A, Goldberg JE, Ashley SW. Acute gastrointestinal hemorrhage. In: Townsend CM (ed.). Sabiston textbook of surgery. Philadelphia: Saunders Elsevier 2007.

5. Farrel JJ, Reber HA. Nonendocrine tumors of the pancreas. In: Yamada T. Textbook of gastroenterology. Oxford: Blackwell Publishing 2009: 1854–1854.

6. Tomita H, Osada S, Matsuo M et al. Pancreatic cancer presenting with hematemesis from directly invading the duodenum: report of an unusual manifestation and review. Am Surg 2006; 72(4): 363–366.

7. Sharon P, Stalnikovicz R, Rachmilewitz D et al. Endoscopic diagnosis of duodenal neoplasms causing upper gastrointestinal bleeding. J Clin Gastroenterol 1982; 4(1): 35–38.

8. Lee P, Sutherland D, Feller ER. Massive gastrointestinal bleeding as the initial manifestation of pancreatic carcinoma. Int J Pancreatol 1994; 15(3): 223–227.

9. Lin YH, Chen CY, Chen CP et al. Hematemesis as the initial complication of pancreatic adenocarcinoma directly invading the duodenum: a case report. World J Gastroenterol 2005; 11(5): 767–769.

10. Celinski K, Cichoz-Lach H, Madro A et al. Non-variceal upper gastrointestinal bleeding – guidelines on management. J Physiol Pharmacol 2008; 59 (Suppl 2): 215–229.

11. Marko Ľ, Kothaj P, Marková I et al. Praktický manažment pacienta s krvácaním do tráviaceho traktu. Banská Bystrica: Marko 2001: 2–8. Dostupné z: http://laparoskopia.info/pdf/MANAGEMENT%20KRVACANIA.pdf.

12. Savides TJ, Jensen DM, Cohen J et al. Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment and outcome. Endoscopy 1996; 28(2): 244.