A Tale of a Fatal Massive Upper Gastrointestinal Bleed in a Patient of Chronic Pancreatitis: A Case Report

Abstract

Aim: Chronic pancreatitis (CP) is associated with venous and arterial complications, some of which may lead to life-threatening haemorrhage. Early identification and appropriate intervention are essential for managing these vascular complications. This report describes the diagnostic evaluation, operative management, postoperative course, and fatal outcome of a young male with chronic pancreatitis who presented with massive upper gastrointestinal bleeding. Presentation of Case: A 33-year-old male with a five-year history of alcohol consumption presented with severe anaemia, leucocytosis, and deranged liver function tests. He subsequently developed haematemesis and melaena. Computed tomography revealed grade III fatty liver, splenic vein occlusion, a thick-walled pancreaticoduodenal collection, gastroduodenal artery encasement, a pseudocyst near the spleen, and chronic calcific pancreatitis. Upper gastrointestinal endoscopy showed a large duodenal bulge with an associated ulcer but no active bleeding. Recurrent haematemesis one week later prompted urgent endoscopy, which demonstrated active bleeding and failed endoscopic haemostasis. Surgical management included midline laparotomy, anterior gastrotomy with evacuation of blood clots, gastric devascularisation, ligation of the encased gastroduodenal artery, duodenal resection, and Roux-en-Y gastrojejunostomy. Despite intensive care, the patient died on postoperative day 14 due to septic shock and multi-organ failure. Discussion and Conclusion: This case highlights the diagnostic and therapeutic complexity of pancreatitis-related upper gastrointestinal bleeding and the need for timely multidisciplinary assessment.