Clinical Management of Pediatric Hemosuccus Pancreaticus: Experience Based on a Case Report and Mini Literature Review
Donghao Tian, Jialu Fu, Hui Yu, Qiang Liu, Yuekui Luo, Baijun Zheng, Ya GaoObjective
Hemosuccus pancreaticus (HP) rarely happens in children, and early diagnosis poses significant challenges. It aims to elucidate the clinical characteristics and management of pediatric HP.
Methods
To retrospectively analyzes a pediatric HP case admitted to our department, along with a narrative literature review.
Results
A 13‐year‐old boy presented intermittent epigastric pain with gastrointestinal bleeding (GIB), who previously suffered from chronic pancreatitis. The emergency gastroscopy showed fresh blood overflow from duodenal papilla, and CT angiography (CTA) revealed a pancreatic tail pseudocyst with splenic artery (SpA) involved and occurring pseudoaneurysm, which suggested HP. Twice interventional therapy yielded hemostatic effect while appeared prone to recurrence, laparoscopic resection of pancreatic pseudocyst, SpA pseudoaneurysm and partial splenectomy was performed. The child did not experience recurrence with follow‐up for 2 years. Another 9 children with the age of 3–18 years were reported; 6 cases were diagnosed via CT arteriography and successfully interventional embolized, and 2 cases were diagnosed and treated using endoscopic ultrasonography (EUS).
Conclusion
Pediatric HP is attributed to peripancreatic pseudoaneurysm ruptured into pancreatic duct to duodenum, secondary to pancreatitis, abdominal surgery, or blunt abdominal trauma. Intermittent epigastric pain, GIB, and elevated blood amylase are common clinical features. Endoscopy often missed diagnosis and even requires repeated examination. CTA is recommended for HP diagnosis. Interventional therapy is the first choice but leading to complications, especially patients with failed interventional, ineffective hemostasis or hemodynamic instability can be treated with laparoscopic surgery. Sometimes, the EUS is alternative. Generally, the children if diagnosed in time present good prognosis.