Acute pancreatitis following endoscopic hemostasis of a periampullary Dieulafoy lesion: successful rescue by endoscopic retrograde cholangiopancreatography

Periampullary Dieulafoy lesions are a rare\r\nsource of upper gastrointestinal bleed-\r\ning. Endoscopic treatment in this region\r\ncarries a risk of post-procedural pancrea-\r\ntitis due to inadvertent papillary obstruc-\r\ntion\r\nUrgent\r\nesophagogastroduodenoscopy revealed\r\nactive bleeding from a periampullary\r\nDieulafoy lesion, treated with epine-\r\nphrine injection and placement of two\r\nendoscopic clips.\r\nFourteen hours later, the patient devel-\r\noped mesogastric pain. Laboratory find-\r\nings showed a marked elevation in amy-\r\nlase (1236 U/L) and a mild increase in\r\nbilirubin (1.3 mg/dL). CT scan reported\r\nduodenal wall hematoma and edema-\r\ntous acute pancreatitis. ERCP confirmed\r\nthat the two endoclips were in place, but one directly over the papillary orifice