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

Periampullary Dieulafoy lesions are a rare source of upper gastrointestinal bleed- ing. Endoscopic treatment in this region carries a risk of post-procedural pancrea- titis due to inadvertent papillary obstruc- tion Urgent esophagogastroduodenoscopy revealed active bleeding from a periampullary Dieulafoy lesion, treated with epine- phrine injection and placement of two endoscopic clips. Fourteen hours later, the patient devel- oped mesogastric pain. Laboratory find- ings showed a marked elevation in amy- lase (1236 U/L) and a mild increase in bilirubin (1.3 mg/dL). CT scan reported duodenal wall hematoma and edema- tous acute pancreatitis. ERCP confirmed that the two endoclips were in place, but one directly over the papillary orifice