Patient with rare cause of GI bleed, saved with even rarer endoscopic procedure

55 year old gentleman came to Shri Mata Vaishno Devi Narayana Superspeciality Hospital with complaints of blood in stools, jaundice and generalized weakness.
He got admitted from emergency after initial resuscitation under Dr Nikhil Mahajan, Consultant Gastroenterology and team in Gastroenterology department.
He was transfused a total of 4 units of blood. After initial stabilisation, Upper GI endoscopy performed by Dr Nikhil Mahajan showed blood coming from papilla (opening of bile duct and pancreatic duct).
CT Angio abdomen showed a large 4 cms pseudo-aneurysm( blood filled sac with impending rupture) of a blood vessel(GDA) communicating with Pancreas duct(PD) causing pain and GI bleed. pseudo aneurysm also caused bile duct( duct from where bile juice comes to digest food) compression causing jaundice.
Options of major surgery for it vis-à-vis interventional radiology occlusion of pseudo aneurysm (expertise not available in hospital) vis-à-vis endoscopic intervention were discussed with attendants in detail
Endoscopic drainage (incision less) of pseudo aneurysm was planned.
It involved Endoscopic ultrasound (ultrasound attached to tip of endoscope) assessment of the lesion followed by puncturing the blood filled sac with needle under vision and then injecting a glue like substance in it which not only occludes the blood sac but also blocks the feeding vessels
Procedure was conducted successfully under conscious sedation and was completed with out any complications in 15 minutes.
Patient was discharged one day after the procedure.
Repeat scan after 1 week showed complete obliteration of blood sac and its resolution too. Jaundice too subsided as blood filled sac causing compression of biliary duct resolved.
Dr Nikhil Mahajan, Interventional Gastroenterologist, conveyed that all kind of diagnostic/ therapeutic endoscopic procedures including ERCP and Endoscopic ultrasound guided procedures( facility only available with us in entire UT) are conducted in SMVD Narayana.
He further added that covid crises cannot dent a doctors confidence and will to work for patients well being. Hospital is effectively managing all non-covid cases with necessary safety measures.

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