Hemosuccus Pancreaticus: A Rare Cause Of GI Bleed

Abstract

Introduction: Hemosuccus pancreaticus, a rare etiology of upper gastrointestinal bleeding, is bleeding from the papilla of Vater through the pancreatic duct into the duodenum. Case Report: A 64-year-old man with history of chronic pancreatitis presented with epigastric abdominal pain of 2 weeks’ duration. Patient underwent a CT scan, which showed partially occluding thrombus of the confluence of the superior mesenteric vein and splenic vein along with changes of chronic pancreatitis. Due to drop in hemoglobin while in hospital, patient underwent red cell tag study, which was positive for bleeding with activity at second portion of duodenum. Patient later underwent EGD showing periampullary area with oozing of blood without any definitive localized lesion. For further evaluation of periampullary area, he had EGD with side-viewing duodenoscope, which confirmed the finding of blood oozing from the ampula. Mesenteric angiogram showed a 1.9-cm splenic artery pseudoaneurysm and minimal intimal irregularity and active extravasation from the inferior pancreaticoduodenal artery. Patient had splenic artery aneurysm coiling, which took care of his gastrointestinal bleeding. Discussion: Hemosuccus pancreaticus is rare entity and often difficult to diagnose. Multiple etiologies can be considered as a culprit, with the most common one being arterial pseudoaneurysm formation secondary to chronic pancreatitis. In patient with known pancreatic disease who presents with upper GI bleeding and abdominal pain, upper endoscopy or appropriate radiological procedure can help to establish accurate diagnosis. Angiographic embolization and surgery are the options for the management and transcatheter intervention is the treatment of choice for the clinically stable patients. Additional innovative treatments have been discussed in literature, but more studies will be needed to confirm the safety and therapeutic effectiveness of those treatment options.