S3329 A Rare Presentation of Life-Threatening Duodenal Bleeding Secondary to Invasive Pancreatic Adenocarcinoma

Introduction: Pancreatic cancer can present with a wide range of symptoms, including abdominal pain, nausea, jaundice, and weight loss. Disease progression can result in invasion to adjacent organs such as the bile duct, stomach, colon, and duodenum. Involvement of the duodenum commonly results in gastrointestinal (GI) obstruction, while life-threatening upper GI bleeding is a rare but serious complication, occurring in approximately 2% of patients with pancreatic cancer. We present a case of upper gastrointestinal bleeding secondary to duodenal involvement by pancreatic adenocarcinoma. Case Description/Methods: A 55-year-old woman with a history of stage II pancreatic adenocarcinoma receiving combination chemotherapy with leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX), presented to the hospital with hematemesis and nausea that began earlier that morning. Notable laboratory findings on admission included a hemoglobin (Hgb) of 5.5 g/dL, requiring multiple units of red blood cell transfusions. A computed tomography scan of the chest, abdomen, and pelvis revealed a stable necrotic cavity within the pancreatic head mass with evidence of fistulization into the duodenum. Subsequent esophagogastroduodenoscopy (EGD) revealed a large ulceration in the distal duodenal bulb extending into the duodenal sweep, with adherent clot and a visible vessel demonstrating active bleeding. Following the procedure, the patient was transferred to the Intensive Care Unit due to high-risk gastrointestinal bleeding and worsening respiratory status. Given her clinical deterioration and prior oncologic history, the patient elected to transition to home hospice care. Discussion: Duodenal bleeding secondary to pancreatic adenocarcinoma is a rare but life-threatening complication. Its low incidence can contribute to delays in recognition, particularly in patients with complex oncologic histories. Tumor invasion of the duodenum should be considered in the differential diagnosis of such patients as early identification is essential for timely intervention. Management strategies include endoscopic hemostasis, arterial embolization, and surgical intervention. In select cases, emergency pancreatoduodenectomy may be considered to achieve hemostasis.