Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2008 May 7;14(17):2776-9.
doi: 10.3748/wjg.14.2776.

Hemosuccus pancreaticus: problems and pitfalls in diagnosis and treatment

Affiliations
Case Reports

Hemosuccus pancreaticus: problems and pitfalls in diagnosis and treatment

Yoshikazu Toyoki et al. World J Gastroenterol. .

Abstract

Hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Interventional radiology is the first modality for early diagnosis and possible treatment of hemosuccus pancreaticus. When angiography shows no abnormal findings or interventional radiological therapy can not be successful, surgery should be considered without delay. Our patients herein underwent surgery without recurrence or sequelae. Intraoperative ultrasonography and pancreatoscopy were helpful modalities for confirming the source of hemorrhage and determining the cutting line of the pancreas. When we encounter intermittent upper gastrointestinal bleeding with an obscure source, hemosuccus pancreaticus should be included in differential diagnoses especially in patients with chronic pancreatitis, which would lead to a prompt and proper treatment.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Case 1. Pseudoaneurysm of splenic artery communicating with pancreatic duct. A: Endoscopy reveals bleeding from papilla of Vater; B: CT scan shows a cystic mass at tail of pancreas; C: Angiography identifies aneurysms at distal portion of splenic artery and right hepatic artery (arrow); D: Operative ultrasonography demonstrates a low echoic mass at body of pancreas suspected as a hematoma (arrow).
Figure 2
Figure 2
Histology of Case 1. A: Pancreatic parenchyma; B: Wall of pseudoaneurysm of splenic artery; C: Orifice of pseudoaneurysm into pancreatic duct; D: Hematoma.
Figure 3
Figure 3
Case 2. Pseudoaneurysm in pancreatic pseudocyst. A: Angiography failed to detect a bleeding point; B: CT scan shows multiple calcifications at the whole pancreas and dilatation of main pancreatic duct; C: Endoscopic retrograde pancreatography displays a dilatated branch of pancreatic duct at head of pancreas (arrow); D: Endoscopy reveals bleeding from papilla of Vater.
Figure 4
Figure 4
Case 2. Intraoperative pancreatoscopy and specimen. A: Pancreatic head by pancreatoscopy; B: Pancreatic tail by pancreatoscopy, and bleeding source was seen; C: Bleeding source at pancreatic tail.

References

    1. Lower WE, Farrell JI. Aneurysm of the splenic artery: Report of a case and review of the literature. Arch Surg. 1931;23:182–190.
    1. Sandblom P. Gastrointestinal hemorrhage through the pancreatic duct. Ann Surg. 1970;171:61–66. - PMC - PubMed
    1. Stanley JC, Frey CF, Miller TA, Lindenauer SM, Child CG 3rd. Major arterial hemorrhage: a complication of pancreatic pseudocysts and chronic pancreatitis. Arch Surg. 1976;111:435–440. - PubMed
    1. Rao RC, Kumar A, Berry M. Pseudoaneurysm of anomalous right hepatic artery as a cause for hemosuccus pancreatitis. Gastrointest Radiol. 1987;12:313–314. - PubMed
    1. Fernandez-Cruz L, Pera M, Vilella A, Llovera JM, Navasa M, Teres J. Hemosuccus pancreaticus from a pseudoaneurysm of the hepatic artery proper in a patient with a pancreatic pseudocyst. Hepatogastroenterology. 1992;39:149–151. - PubMed

Publication types

MeSH terms