Bleeding from the papilla Vateri – rare form of gastrointestinal bleeding

Introduction: Bleeding through the papilla Vateri is a rare and insidiously occurring type of gastrointestinal bleeding. The correct diagnosis is difficult thus the therapy is hindered. In chronic pancreatitis pseudoaneurysm can develop if a pancreatic vessel is damaged by the growing pseudocyst. Such bleeding may lead to a life threatening condition, thus necessitating urgent diagnostic and therapeutic measures. Case report: We report on the case of a 52 year old man, who was acutely admitted to our hospital for epigastric pain and gastrointestinal bleeding. He had unstable circulation and his haemoglobin level was 5.2g/dl. Urgent gastroscopy revealed bleeding through the papilla Vateri. Abdominal US described enlarged pancreas with cystic lesions in the head. Doppler did not show turbulence in the cysts. Angio CT described a pseudoaneurysm in the head of the pancreas with possible bleeding from a branch of the superior mesenteric artery. Angiography proved the diagnosis and embolisation of the bleeding artery was performed. Some days later the bleeding recurred and was treated conservatively. We performed a scheduled operation where we found the pseudoaneurysm. A cysto-jejunostomy was done. After uneventful recovery the patient was discharged with no further bleeding on the 8th postoperative day. Conclusion: Bleeding can be a rare, but life threatening complication of chronic pancreatitis. Radiological intervention can be of use but in case of failure surgery remains the therapy of choice.