P2954 - A Riveting Tale of Pancreatojejunostomy Bleeding in a Pregnant Patient: A Unique Clinical Encounter

Ahmed Salih, MD¹, Sasmith Menakuru, MD¹, Natasha Dudiki, MD², Yan Bi, MD, PhD^3
1Indiana University School of Medicine, Muncie, IN; ²IU Ball Memorial, Muncie, IN; ³Mayo Clinic, Jacksonville, FL

Introduction: Pancreatojejunostomy (PJ) is a reconstructive surgical procedure designed to minimize post-pancreatectomy leakage. While GI bleeding can be a complication in the first few weeks after surgery, it is very uncommon to occur years after. This case presents a rare encounter of massive PJ bleeding in a pregnant patient sixteen years after the procedure.

Case Description/Methods: The 35-year-old 6 weeks pregnant patient, who had previously undergone an open central pancreatectomy with PJ for a pseudopapillary neoplasm in 2007, presented with hematochezia. She was in hemorrhagic shock on presentation. Initial investigations revealed a critically low hemoglobin of 5.1 gm/dl. She was started on a high-dose proton pump inhibitor and octreotide infusion. Emergent upper endoscopy and push enteroscopy revealed significant amounts of hematin in the stomach, duodenum, and jejunum, with no active source of bleeding found. An interventional radiology consult and a subsequent angiography showed gastric varices and a small splenic pseudoaneurysm but no active extravasation of contrast. The patient's hemodynamic status continued to deteriorate, necessitating intensive care and a massive transfusion of over 60 units of blood products. Ultimately, an exploratory laparotomy revealed bleeding from the PJ, which was successfully treated with clipping. The patient's condition stabilized postoperatively, and she experienced a satisfactory recovery with no fetal harm.

Discussion: PJ is a surgical procedure performed to restore the panceato-digestive continuity after pancreatic resection. It is also used to relieve pain in patients with chronic pancreatitis. However, this procedure is associated with significant complications such as pancreatic fistulas and bleeding. While bleeding is not uncommon in the months following surgery, it is extremely rare for it to happen years later. The diagnosis of such cases is challenging due to anatomical distortions and difficulties in accessing the affected area. In our patient's situation, the diagnosis was made even more challenging due to the patient's remote history of PJ surgery. Additionally, the patient's pregnancy introduced further complexity, requiring us to investigate promptly and meticulously to arrive at an accurate diagnosis. Nonetheless, our timely and comprehensive intervention proved successful in preserving both the patient's life and her pregnancy. This outcome underscores the importance of swift and thorough medical intervention in critical situations like these.


Disclosures:


Ahmed Salih, MD¹, Sasmith Menakuru, MD¹, Natasha Dudiki, MD², Yan Bi, MD, PhD³. P2954 - A Riveting Tale of Pancreatojejunostomy Bleeding in a Pregnant Patient: A Unique Clinical Encounter, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.