Question

A 52 year old patient arrives to the emergency department with severe abdominal pain radiating towards the back and vomiting. Clinical and laboratory diagnosis of an acute pancreatitis was made and subsequent treatment was given which improved the patients condition. After a few days the patient begins with black stools and hemodynamic instability which was resolved with normal saline and ionotropics. Upper endoscopic studies were made revealing no varices in esophagus nor visible lesions in the body of the stomach, but there was fresh blood in the stomach. Which of the following vessels would most likely be involved in this complication?

a) short gastric veins
b) left gastric veins
c) portal vein
d) right gastric vein
e) great pancreatic vein.

Answer 1

The vessel most likely involved in the upper gastrointestinal bleeding in a patient with acute pancreatitis and fresh blood in the stomach, but no visible stomach or esophageal lesions, is the great pancreatic vein.

Step-by-step explanation:

A patient with a clinical and laboratory diagnosis of acute pancreatitis experiences a subsequent complication of upper gastrointestinal bleeding, indicated by the presence of black stools (melena) and hemodynamic instability. After receiving treatment that stabilized the patient, an upper endoscopy was performed, which revealed fresh blood in the stomach but no visible lesions in the stomach or esophageal varices. Considering the endoscopic findings and the location of the bleeding, the vessel most likely involved in this complication is the great pancreatic vein, which drains blood from the pancreas into the splenic vein, and subsequently into the portal system. Since the pancreas is the initial site of inflammation, and a major complication of pancreatitis can involve bleeding from the pancreatic vessels, the involvement of the great pancreatic vein would explain the presence of fresh blood in the stomach.