An undetectable source of recurrent gastrointestinal bleeding: hemosuccus pancreaticus

Excerpt

A 57-year-old man was referred to the Emergency Room of our medical center for an episode of melena and multiple episodes of rectorrhagia during the last 3 days associated with intermittent abdominal pain. The patient had a history of chronic lithiasic pancreatitis, arterial hypertension, psoriasis, and a localized renal cell carcinoma treated with nephrectomy in 2017. Due to his oncologic surveillance program, he had recently performed an abdominal RM which had shown a fluid collection upon the body of pancreas compatible with a pancreatic pseudocyst. Actually, this patient was already known to our hospital, as 1 year before he had performed repeated accesses to our emergency department for repeated episodes of rectorrhagia, melena, and anemization and was hospitalized multiple times. First, in the april of 2019, he underwent an esophagogastroduodenoscopy (EGDS), a pancolonoscopy with retrograde ileoscopy, a videocapsule endoscopy, and a push-and-pull enteroscopy, which resulted negative for every gastrointestinal source of bleeding, and was therefore discharged; after few months, he was hospitalized again two more times for the same symptomatology, so he underwent again several angiography-CT scans, repeated endoscopic exams and even a scintigraphy with marked red blood cells, but no active bleeding sources or cause of gastrointestinal were found. Thus, he was discharged with a diagnosis of occult hemorrhage and prescribed long-acting octreotide. Then the patient was lost at follow-up due to the COVID-19 pandemic. He had self-suspended the administration of the drug after 6 months from last discharge. …