Hematemesis as the initial manifestation of pancreatic cancer directly invading the duodenum: a case report

Pancreatic cancer is a rare cause of gastrointestinal bleeding, and it is extremely rare for hematemesis to be the initial manifestation of invasive pancreatic cancer. We report the case of a 62-year-old man with hematemesis who was found to have a profound ulcer on transverse duodenum by fiberscopy. CT scan showed an ill-defined low density mass on the transverse duodemum. Biopsy specimen revealed adenocarcimoma. Ten days after first hematemesis, the patient again suffered massive hematemesis causing hypovolemic shock and underwent emergency angiography revealing extravasation from the second jejunal artery to the transverse duodenum. Transcatheter arterial embolization (TAE) was performed and the bleeding was stopped. Twelve days after TAE, resection of the transverse duodenum was performed and microscopic examination revealed that pancreatic cancer originating from the uncus of the pancreas extended to the transverse duodemum and involved the superior mesenteric artery and jejunal arteries and, finally, the second jejunal artery ruptured to the duodenum.