English

Abstract

Pleural effusions in acute pancreatitis are usually small, occasionally bloody, characterized by high amylase, protein levels.1 Majority of pleural effusions secondary to pancreatitis are left-sided (68 %) or bilateral (22 %) and only 10 % are right sided. Hemosuccus pancreaticus (HP) is caused by rupture of aneurysm of a peripancreatic vessel into pancreatic duct or pancreatic pseudocyst in the context of pancreatitis. HP is the least frequent cause of upper gastrointestinal bleeding (1 / 1500), but can lead to potentially life threatening2 massive gastrointestinal bleeding. Hemosuccus pancreaticus is defined as bleeding from the ampulla of Vater via pancreatic duct. It is due to a bleeding source in the pancreas, pancreatic duct, or structures adjacent to the pancreas, like the gastroduodenal and splenic artery. The most common cause is a pseudoaneurysm of peripancreatic arteries due to acute or chronic pancreatitis.3,4 Other rare causes are trauma,5 rupture of a true aneurysm,6 pancreatic tumours,7 arteriovenous (AV) malformations,8 endoscopic ultrasoundguided fine needle aspiration from pancreatic cyst9 etc.