Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding

Abstract

Hemorrhage from the pancreatic duct, referred to as hemosuccus pancreaticus or pseudohemobilia, is a rare cause of gastrointestinal (GI) bleeding. This potentially life-threatening complication of pancreatitis may pose a significant diagnostic and therapeutic dilemma, especially in patients who do not exhibit symptoms such as abdominal pain, jaundice, or GI bleeding. Here we describe a 55-year-old male with a known history of chronic calcifying pancreatitis, who presented with repeated episodes of melena associated with paroxysms of abdominal pain and frequent drop in hemoglobin requiring hospitalization. Initial endoscopic evaluation was negative. Endoscopy was repeated after an episode of melena which showed blood spurting from the ampulla. Further evaluation with abdominal CT scan, CT angiogram and conventional angiogram revealed no source of blood loss. Hence emergency surgery was done. There was evidence of splenic vein rupturing into the pancreatic duct.

Keywords: Chronic calcifying pancreatitis; GI bleeding; hemosuccus pancreaticus.

Figure 1

CT abdomen showing chronic calcifying pancreatitis P, pancreas; C, calcification

Figure 2

Esophagogastroduodenoscopy showing evidence of blood actively spurting from ampulla

Figure 3

EUS showing evidence of chronic pancreatitis with inflammatory mass (arrow head showing inflammatory mass)

Figure 4

(A) Histopathologica examination showing evidence of chronic calcifying pancreatitis and (B) splenic congestion